title: [Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial].
abstract: 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.
authors.affiliation: Universitair Medisch Centrum Utrecht, Utrecht. groenendijk-koeman@orange.nl
authors.forename: M
authors.initials: M
authors.lastname: Koeman
authors.forename: A J A M
authors.initials: AJ
authors.lastname: van der Ven
authors.forename: E
authors.initials: E
authors.lastname: Hak
authors.forename: J C A
authors.initials: JC
authors.lastname: Joore
authors.forename: H A H
authors.initials: HA
authors.lastname: Kaasjager
authors.forename: A M G A
authors.initials: AM
authors.lastname: de Smet
authors.forename: G
authors.initials: G
authors.lastname: Ramsay
authors.forename: T P J
authors.initials: TP
authors.lastname: Dormans
authors.forename: L P H J
authors.initials: LP
authors.lastname: Aarts
authors.forename: E E
authors.initials: EE
authors.lastname: de Bel
authors.forename: W N M
authors.initials: WN
authors.lastname: Hustinx
authors.forename: I
authors.initials: I
authors.lastname: van der Tweel
authors.forename: I M
authors.initials: IM
authors.lastname: Hoepelman
authors.forename: M J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D010919:Placebos; D002710:Chlorhexidine; D003091:Colistin