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Tytuł:
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Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.
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Autorzy:
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Koeman M; University Medical Center Utrecht, Department of Internal Medicine and Dermatology, and Department of Internal Medicine and Intensive Care Medicine, Rijnstate Hospital Arnhem, The Netherlands. />van der Ven AJ
Hak E
Joore HC
Kaasjager K
de Smet AG
Ramsay G
Dormans TP
Aarts LP
de Bel EE
Hustinx WN
van der Tweel I
Hoepelman AM
Bonten MJ
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Źródło:
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American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2006 Jun 15; Vol. 173 (12), pp. 1348-55. Date of Electronic Publication: 2006 Apr 07.
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Typ publikacji:
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Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
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MeSH Terms:
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Anti-Infective Agents, Local/*therapeutic use
Chlorhexidine/*therapeutic use
Mouth/*drug effects
Pneumonia, Bacterial/*prevention & control
Ventilators, Mechanical/*adverse effects
Administration, Topical ; Adult ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents, Local/administration & dosage ; Chlorhexidine/administration & dosage ; Colistin/administration & dosage ; Colistin/therapeutic use ; Critical Care ; Double-Blind Method ; Drug Combinations ; Female ; Gram-Negative Bacteria/isolation & purification ; Gram-Positive Bacteria/isolation & purification ; Humans ; Length of Stay ; Male ; Middle Aged ; Mouth/microbiology ; Oropharynx/microbiology ; Placebos ; Time Factors ; Trachea/microbiology
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Substance Nomenclature:
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0 (Anti-Bacterial Agents)
0 (Anti-Infective Agents, Local)
0 (Drug Combinations)
0 (Placebos)
R4KO0DY52L (Chlorhexidine)
Z67X93HJG1 (Colistin)
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Entry Date(s):
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Date Created: 20060411 Date Completed: 20060713 Latest Revision: 20220330
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Update Code:
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20240104
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DOI:
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10.1164/rccm.200505-820OC
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PMID:
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16603609
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Rationale: Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of antibiotic-resistant pathogens. We hypothesized that oral decontamination with either chlorhexidine (CHX, 2%) or CHX/colistin (CHX/COL, 2%/2%) would reduce and postpone development of VAP, and oral and endotracheal colonization.
Objectives: To determine the effect of oral decontamination with CHX or CHX/COL on VAP incidence and time to development of VAP.
Methods: Consecutive patients needing mechanical ventilation for 48 h or more were enrolled in a randomized, double-blind, placebo-controlled trial with three arms: CHX, CHX/COL, and placebo (PLAC). Trial medication was applied every 6 h into the buccal cavity. Oropharyngeal swabs were obtained daily and quantitatively analyzed for gram-positive and gram-negative microorganisms. Endotracheal colonization was monitored twice weekly.
Results: Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX/COL. Baseline characteristics were comparable. The daily risk of VAP was reduced in both treatment groups compared with PLAC: 65% (hazard ratio [HR]=0.352; 95% confidence interval [CI], 0.160, 0. 791; p=0.012) for CHX and 55% (HR=0.454; 95% CI, 0.224, 0. 925; p=0.030) for CHX/COL. CHX/COL provided significant reduction in oropharyngeal colonization with both gram-negative and gram-positive microorganisms, whereas CHX mostly affected gram-positive microorganisms. Endotracheal colonization was reduced for CHX/COL patients and to a lesser extent for CHX patients. No differences in duration of mechanical ventilation, intensive care unit stay, or intensive care unit survival could be demonstrated.
Conclusions: Topical oral decontamination with CHX or CHX/COL reduces the incidence of VAP.
Comment in: Am J Respir Crit Care Med. 2006 Jun 15;173(12):1297-8. (PMID: 16760355)
Comment in: ACP J Club. 2006 Nov-Dec;145(3):68. (PMID: 17080980)
Comment in: Evid Based Nurs. 2007 Jan;10(1):19. (PMID: 17218293)
Comment in: Am J Respir Crit Care Med. 2007 Feb 15;175(4):418. (PMID: 17277293)
Comment in: Pediatr Crit Care Med. 2009 Mar;10(2):242-5. (PMID: 19188868)
