[Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial].
OBJECTIVE
To determine the effect of oral decontamination with either chlorhexidine (CHX, 2%) or the combination chlorhexidine-colistin (CHX-COL, 2%-2%) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients.


METHODS
Double blind, placebo-controlled, multicentre, randomised trial.


METHODS
Consecutive ICU patients needing at least 48 h of mechanical ventilation were enrolled in a randomized trial with 3 arms: CHX, CHX-COL, and placebo (PLAC). The trial medication was administered in the oral cavity every 6 h. Oropharyngeal swabs were obtained daily and analysed quantitatively for Gram-positive and Gram-negative microorganisms. Endotracheal colonisation was monitored twice weekly. Ventilator-associated pneumonia was diagnosed on the basis of a combination of clinical, radiological and microbiological criteria.


RESULTS
Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX-COL. Baseline characteristics in the three groups were comparable. The daily risk of ventilator-associated pneumonia was reduced in both treatment groups compared to PLAC: 65% (HR= 0.352; 95% 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 a significant reduction in oropharyngeal colonisation with both Gram-negative and Gram-positive microorganisms, whereas CHX significantly affected only colonisation with Gram-positive microorganisms. There were no differences in the duration of mechanical ventilation, ICU-stay or ICU-survival.


CONCLUSIONS
Oral decontamination of the oropharyngeal cavity with chlorhexidine or the combination chlorhexidine-colistin reduced the incidence and the time to onset ofventilator-associated pneumonia.
Koeman
M
M
Universitair Medisch Centrum Utrecht, Utrecht. groenendijk-koeman@orange.nl
van der Ven
A J A M
AJ
Hak
E
E
Joore
J C A
JC
Kaasjager
H A H
HA
de Smet
A M G A
AM
Ramsay
G
G
Dormans
T P J
TP
Aarts
L P H J
LP
de Bel
E E
EE
Hustinx
W N M
WN
van der Tweel
I
I
Hoepelman
I M
IM
Bonten
M J M
MJ
D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D003422:Critical Care; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000187:drug effects* / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology; D010919:Placebos; D018410:Pneumonia, Bacterial / Q000517:prevention & control*; D013997:Time Factors; D014132:Trachea / Q000382:microbiology; D012122:Ventilators, Mechanical / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D010919:Placebos; D002710:Chlorhexidine; D003091:Colistin