The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial.
BACKGROUND
Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics.


METHODS
Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation.


RESULTS
Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia (p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type.


CONCLUSIONS
The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation.
Hirota
W K
WK
Gastroenterology Service, Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
Wortmann
G W
GW
Maydonovitch
C L
CL
Chang
A S
AS
Midkiff
R B
RB
Wong
R K
RK
Moses
F M
FM
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D001419:Bacteria / Q000302:isolation & purification; D002981:Clindamycin / Q000008:administration & dosage*; D004106:Dilatation / Q000009:adverse effects* / Q000295:instrumentation; D004940:Esophageal Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes; D011446:Prospective Studies; D016037:Single-Blind Method
D000900:Anti-Bacterial Agents; D009067:Mouthwashes; D002981:Clindamycin