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Effectiveness of Bath Wipes After Hematopoietic Cell Transplantation: A Randomized Trial
Margie Kjellin1, Amr Qudeimat1, Emily Browne1
1St. Jude Children's Research Hospital, Memphis, TN, USA.
Insights
Silver-containing bath wipes and standard soap wipes showed similar effectiveness in preventing vancomycin-resistant enterococci (VRE) and multidrug-resistant gram-negative rods (MDR GNRs) infections in children undergoing hematopoietic cell transplantation (HCT). Both methods resulted in low rates of colonization and bacteremia.
Area of Science:
- Infectious Diseases
- Hematology
- Microbiology
Background:
- Bacteremia poses significant risks for children undergoing hematopoietic cell transplantation (HCT), with vancomycin-resistant enterococci (VRE) and multidrug-resistant gram-negative rods (MDR GNRs) being common pathogens.
- Effective strategies for preventing infections in immunocompromised pediatric patients are crucial for improving outcomes.
Purpose of the Study:
- To evaluate the efficacy of experimental silver-containing bath wipes compared to standard soap-based wipes in reducing skin colonization of VRE and MDR GNRs.
- To assess the impact of these interventions on nonmucosal barrier injury bacteremia in pediatric HCT recipients.
Main Methods:
- A randomized trial involving pediatric patients undergoing autologous or allogeneic HCT.
- Patients received either silver-containing or standard bath wipes for 60 days post-HCT.
- Skin swabs were collected at baseline, discharge, and day +60 to monitor VRE colonization rates.
Main Results:
- Both silver-containing and standard bath wipes were well-tolerated by patients.
- Interim analysis showed very low rates of VRE colonization (2% experimental vs. 3% standard) and no nonmucosal barrier injury bacteremia in the experimental arm compared to 3% in the standard arm.
- No multidrug-resistant gram-negative rods (MDR GNRs) were isolated; the study was halted due to equivalent efficacy.
Conclusions:
- Skin cleansing with either silver-containing or standard bath wipes achieved low and comparable rates of VRE colonization and bacteremia in pediatric HCT patients.
- Further research in other high-risk populations is warranted to confirm these findings on infection prevention.
Abstract:
Objective: Bacteremia is a leading cause of morbidity and mortality in children undergoing hematopoietic cell transplantation (HCT). Infections of vancomycin-resistant enterococci (VRE) and multidrug resistant (MDR) gram-negative rods (GNRs) are common in this population. Our objective was to assess whether experimental bath wipes containing silver were more effective than standard bath wipes containing soap at reducing skin colonization by VRE and MDR GNRs, and nonmucosal barrier injury bacteremia. Study Design: Patients undergoing autologous or allogeneic HCT in a tertiary referral center were randomized to receive experimental or standard bath wipes for 60 days post-HCT. Skin swabs were collected at baseline, discharge, and day +60 post-HCT. The rate of VRE colonization was chosen as the marker for efficacy. Results: Experimental bath wipes were well tolerated. Before the study, the rate of colonization with VRE in HCT recipients was 25%. In an interim analysis of 127 children, one (2%) patient in the experimental arm and two (3%) in the standard arm were colonized with VRE. Two (3%) patients had nonmucosal barrier injury bacteremia in the standard arm, with none in the experimental arm. MDR GNRs were not isolated. The trial was halted because the interim analyses indicated equivalent efficacy of the two methods. Conclusions: Skin cleansing with silver-containing or standard bath wipes resulted in very low and equivalent rates of bacteremia and colonization with VRE and MDR GNRs in children post-HCT. Future studies in other high-risk populations are needed to confirm these results.
