title: Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients.
  
  
  METHODS
  Systematic review and meta-analysis of published studies.
  
  
  METHODS
  Intensive care unit.
  
  
  METHODS
  The study comprised critically ill patients receiving oral chlorhexidine (test group) and placebo or standard oral care (control group).
  
  
  METHODS
  PubMed and the Cochrane Register of Controlled Trials were searched. Odds ratios (ORs) were pooled using the random-effects model.
  
  
  RESULTS
  Five studies including 1,655 patients (832 chlorhexidine and 823 control patients) were identified. The majority of information was from studies at low or unclear risk bias; 1 study was at high risk of bias. Bloodstream infection and mortality were not reduced significantly by chlorhexidine (OR 0.74; 95% confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53, respectively). In the subgroup of surgical, mainly cardiac, patients, chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97). Chlorhexidine did not affect any microorganism significantly.
  
  
  CONCLUSIONS
  In critically ill patients, oropharyngeal chlorhexidine did not reduce bloodstream infection and mortality significantly and did not affect any microorganism involved. The presence of a high risk of bias in 1 study and unclear risk of bias in others may have affected the robustness of these findings.
authors.affiliation: Department of Anaesthesia and Intensive Care, S. Giovanni di Dio Hospital, Gorizia, Italy; Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. Electronic address: lucianosilvestri@yahoo.it.
authors.forename: Luciano
authors.initials: L
authors.lastname: Silvestri
authors.affiliation: Department of Cardiothoracic Surgery, London Chest Hospital, London, UK.
authors.forename: William I
authors.initials: WI
authors.lastname: Weir
authors.affiliation: Department of Cardiological, Thoracic and Vascular Sciences, Unit of Biostatistics Epidemiology and Public Health, University of Padova, Padova, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.affiliation: Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: Nia
authors.initials: N
authors.lastname: Taylor
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Durk F
authors.initials: DF
authors.lastname: Zandstra
authors.affiliation: Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: Joris J M
authors.initials: JJM
authors.lastname: van Saene
authors.affiliation: Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors.forename: Hendrick K F
authors.initials: HKF
authors.lastname: van Saene
mesh_terms: D000284:Administration, Oral; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D002710:Chlorhexidine / Q000008:administration & dosage*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: bacteremia; bloodstream infection; chlorhexidine; oral care; oral hygiene; oral rinse