Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis

Lilibetha Pineda,Alia El Solh,Ranimeg Saliba

doi:10.1186/cc4837

Lilibetha Pineda, Alia El Solh + Show 1 more

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https://doi.org/10.1186/cc4837

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Abstract

IntroductionNosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation.MethodsThis study is a meta-analysis of randomized controlled trials assessing the effect of chlorhexidine on the incidence of nosocomial pneumonia. Data sources were Medline, EMBASE, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Out of 1,251 articles screened, 4 randomized, controlled trials were identified that included a total of 1,202 patients. Descriptive and outcome data were extracted by two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, and mortality. A random effects model was used.ResultsThe incidence of nosocomial pneumonia in the control group was 7% (41 out of 615) compared to 4% (24 out of 587) in the treatment group. Gram-negative bacteria accounted for 78% of the total isolates, with Pseudomonas aeruginosa being the most frequently isolated pathogen irrespective of the intervention provided. Duration of mechanical ventilation and intensive care unit length of stay were comparable between the two groups. Overall, the use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia (odds ratio of 0.42; 95% confidence interval 0.16–1.06) or the mortality rate (odds ratio 0.77, 95% confidence interval 0.28–2.11).ConclusionThe use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate. The lack of benefit may reflect the few studies conducted in this area. Future trials should focus on a combination strategy of mechanical and pharmacological interventions.

Highlights

Nosocomial pneumonia is a significant cause of inhospital morbidity and mortality
The use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia or the mortality rate
The use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate

Summary

Introduction

Nosocomial pneumonia is a significant cause of inhospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Multiple hospital-associated risk factors for NP have been identified These risk factors are thought to contribute to increased bacterial colonization of the aerodigestive tract and/ or facilitate entry of pathogenic bacteria to the lower respiratory tract. While the oral flora of a healthy individual is largely composed of viridans streptococcus, the oral flora undergoes a major shift during intensive care unit (ICU) stay from Gram-positive streptococci to predominantly Gram-negative organisms, including pathogens responsible for NP The role of these pathogens are highlighted in epidemiological studies showing a high concordance between the bacteria isolated from the oropharyngeal cavity and those recovered from tracheal aspirates [4,5]. Multiple interventional trials have been initiated to assess the efficacy

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