Oropharyngeal decontamination in intensive care patients: less is not more.
Ventilator-associated pneumonia (VAP) is a common cause of morbidity, antibiotic use, increased length of stay and, possibly, increased mortality in ICU patients. Colonization of the oropharyngeal cavity with potentially pathogenic micro-organisms is instrumental in the pathogenesis of VAP, and selective oropharyngeal decontamination (SOD) with antibiotics (AB-SOD) or antiseptics, such as chlorhexidine gluconate (CHX-SOD), has been associated with reduced incidences of VAP. In a recent issue of Critical Care Scannapieco and colleagues investigated differences in oropharyngeal colonization between mechanically ventilated patients receiving oropharyngeal decontamination with 0.12% CHX-SOD either once or twice daily compared to placebo. CHX-SOD was associated with a reduction in Staphylococcus aureus colonization, but the study was underpowered to demonstrate a reduction in VAP incidence. We urgently need well-designed and adequately powered studies to evaluate the potential benefits of CHX-SOD on patient outcome in ICUs.
Derde
Lennie P G
LP
Julius Center for Health Sciences and Primary Care, Heidelberglaan 100, Location Stratenum, 3584 CX Utrecht, The Netherlands. lderde@umcutrecht.nl
Bonten
Marc J M
MJ
D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D003422:Critical Care; D006801:Humans; D009960:Oropharynx / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects; D013242:Sterilization / Q000379:methods*
D000890:Anti-Infective Agents; C010882:chlorhexidine gluconate; D002710:Chlorhexidine