Crti Care 2008 Nov 6;12(6) R136 Epub ahead of print
INTRODUCTION: Ventilator-associated pneumonia (VAP) is usually caused by aspiration of pathogenic bacteria from the oropharynx, and hence oral decontamination with antiseptics such as chlorhexidine (CHX) or antibiotics has been used as prophylaxis against this complication. We hypothesised that the probiotic bacterium Lactobacillus plantarum 299 (Lp299) would be just as efficient as CHX in reducing the pathogenic bacterial load in the oropharynx of tracheally intubated, mechanically ventilated, critically ill patients.
METHODS: Fifty critically ill patients on mechanical ventilation were randomised to either oral mechanical cleansing followed by washing with 0.1% CHX solution or to the same cleansing procedure followed by oral application of an emulsion of Lp299. Samples for microbiological analyses were taken from the oropharynx and from the trachea at inclusion and thereafter at defined intervals.
RESULTS: Potentially pathogenic bacteria that were not present at inclusion were identified in oropharyngeal samples from eight of the patients treated with Lp299 and thirteen of those treated with CHX (p = 0.13). Analysis of tracheal samples yielded similar results. Lp299 was recovered from the oropharynx of all patients in the Lp299 group.
CONCLUSIONS: In this pilot study, we found no difference between Lp299 and CHX used in oral care procedures, when we examined the effects of those agents on colonisation of potentially pathogenic bacteria in the oropharynx of intubated, mechanically ventilated patients.
Sample 數太小了,很難有定論. 而且減少oropharyngeal field 可能致病菌跟 CHX 相當,我也看過用H2O2 的study......
'We are all just prisoners here of our own device'
Am J Respir Crit Care Med. 2006 Jun 15;173(12):1348-55
RATIONALE: Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of antibiotic-resistant pathogens. We hypothesized that oral decontamination with either chlorhexidine (CHX, 2%) or CHX/colistin (CHX/COL, 2%/2%) would reduce and postpone development of VAP, and oral and endotracheal colonization.
OBJECTIVES: To determine the effect of oral decontamination with CHX or CHX/COL on VAP incidence and time to development of VAP. METHODS: Consecutive patients needing mechanical ventilation for 48 h or more were enrolled in a randomized, double-blind, placebo-controlled trial with three arms: CHX, CHX/COL, and placebo (PLAC). Trial medication was applied every 6 h into the buccal cavity. Oropharyngeal swabs were obtained daily and quantitatively analyzed for gram-positive and gram-negative microorganisms. Endotracheal colonization was monitored twice weekly.
RESULTS: Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX/COL. Baseline characteristics were comparable. The daily risk of VAP was reduced in both treatment groups compared with PLAC: 65% (hazard ratio [HR]=0.352; 95% confidence interval [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 significant reduction in oropharyngeal colonization with both gram-negative and gram-positive microorganisms, whereas CHX mostly affected gram-positive microorganisms. Endotracheal colonization was reduced for CHX/COL patients and to a lesser extent for CHX patients. No differences in duration of mechanical ventilation, intensive care unit stay, or intensive care unit survival could be demonstrated.
CONCLUSIONS: Topical oral decontamination with CHX or CHX/COL reduces the incidence of VAP.
'We are all just prisoners here of our own device'
BACKGROUND: Oral and oropharyngeal decontamination is one of the main issues for preventing ventilator-associated pneumonia (VAP). OBJECTIVE: The objective of the study was to detect and compare in vitro antibacterial activities of 3 oral care products (OCP) against major VAP pathogens.
METHODS: Stabilized hydrogen peroxide (H(2)O(2)); 0.2% chlorhexidine gluconate (CHX); and a commercial product including glucose oxidase, lactoperoxidase, lysozyme, and lactoferrin (GLLL) were selected for this study. In total, 32 VAP isolates were studied by 2 different methods. Bacterial suspension was inoculated onto OCP-absorbed plates in the first method, and OCP was dropped onto bacteria inoculated plates in the second method. Two different bacterial suspensions were used as 10(-2) and 10(-4) dilutions of 0.5 McFarland turbidity.
RESULTS: In the first method, 6 (18%), 6 (18%), and 0 isolates in 10(-2) dilution and 13 (40%), 19 (59.3%), and 2 (6.2%) isolates in 10(-4) dilution of 0.5 McFarland bacterial turbidity were inhibited by CHX, H(2)O(2), and GLLL, respectively. In the second method, 31 (96.8%), 30 (93.7%), and 0 isolates in 10(-2) dilution and 32 (100%), 32 (100%), and 5 (15.6%) isolates in 10(-4) dilution were suppressed. In all dilutions and methods, antibacterial activity of CHX and H(2)O(2) were found more effective than GLLL against VAP pathogens (P < .05).
CONCLUSION: CHX and H(2)O(2) have good antibacterial effects against most isolated VAP pathogens in vitro. They could be suggested as oropharyngeal decontamination agents for reducing VAP incidence.
'We are all just prisoners here of our own device'
