Oral Antiseptic Lowers Ventilator-Associated Pneumonia

Researchers at the University Medical Center (Utrecht, The Netherlands) used chlorhexidine as an oral decontaminant paste to treat 127 intubated ventilated patients. The investigators treated a separate group of 128 ventilated patients with a paste composed of chlorhexidine and the antibiotic colistin. A third group of 130 ventilated patients were given a placebo paste. All 385 patients who were enrolled consecutively in the study needed mechanical ventilation for at least 48 hours at two university hospitals and three general hospitals in the Netherlands.

The trial medication in the form of a paste was applied every six hours inside the mouth, and oropharyngeal swabs were taken daily to determine the level of Gram-positive and Gram-negative microorganisms. Of the 385 patients in the study cohort, 52 were diagnosed with VAP: 23 in the placebo group (18%); 13 in the chlorhexidine group (10%); and 16 in the combination group (13%). In comparison to the placebo, the chlorhexidine paste reduced the risk of VAP by 65% and the chlorhexidine/colistin combination cut the risk by 55%. The results appeared in the June 15, 2006, issue of the American Journal of Respiratory and Critical Care Medicine.

"The interventions tested cost less than U.S.$100 per patient, making them extremely cost effective,” said lead author Mirelle Koeman, M.D., Ph.D., of the department of emergency medicine and infectious diseases at the University Medical Center.

Mechanically ventilated patients have an endotracheal tube inserted through either their nose or mouth into the windpipe (trachea) to maintain an open airway, deliver oxygen, and to suction mucus. The endotracheal tube raises the risk of VAP up to 20 times by allowing bacteria present in the oral cavity to access the lungs. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of antibiotic-resistant pathogens.


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