Prospective observational study to compare oral topical metronidazole versus 0.2% chlorhexidine gluconate to prevent nosocomial pneumonia.
Nosocomial pneumonia is one of the most common health care-associated infections in intensive care units (ICUs) worldwide, attributing to high morbidity and mortality. Our study aim is to investigate the effectiveness of oral hygiene with 0.2% chlorhexidine gluconate (CHX) and 0.08% metronidazole (MDE) influencing the microbiologic epidemiology and incidence of nonintubation pneumonia (NIP) and ventilator-associated pneumonia (VAP).



Patients who stayed >48 hours in the emergency ICU between 2008 and 2012 were enrolled and provided oral hygiene by swabbing with 0.08% MDE twice daily until discharge or death during the first year (period M), whereas CHX was applied during the following 3 years (period C). The incidence and microbiologic epidemiology of NIP and VAP were studied.



There were 873 patients enrolled. There were 44 episodes of NIP and 25 episodes of VAP that occurred among 212 patients in period M, and 84 episodes of NIP and 49 episodes of VAP occurred among 661 patients in period C. Overall, the rate of NIP and VAP decreased year by year. Acinetobacter baumannii was the most frequently identified bacteria for NIP (22.9%) and VAP (25.3%), with an annual ascent. Few changes were observed on bacteria distribution for NIP and VAP.



Oral hygiene with CHX, having reduced the incidence of nosocomial pneumonia among critical ill patients, suggests a benefit of oral hygiene in decreasing the incidence of nosocomial pneumonia, including VAP in ICUs, but not bacterial epidemiology.
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Ying
Y
Chen
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
En-Qiang
EQ
Mao
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Yi-Jun
YJ
Yang
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Shu-Yuan
SY
Zhao
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Cheng
C
Zhu
Department of Respiratory Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Xiao-Fei
XF
Wang
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Feng
F
Jing
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Hui-Qiu
HQ
Sheng
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Pôle Sino-Français de Recherches en Science du Vivant et Génomique, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. Electronic address: yangzhitao@hotmail.fr.
Zhi-Tao
ZT
Yang
Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Er-Zhen
EZ
Chen
D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies
D008795:Metronidazole; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
Chlorhexidine gluconate; Intensive care units; Nosocomial pneumonia; Oral hygiene; Ventilator-associated pneumonia