Impact of multizonal decontamination of upper respiratory tract on incidence of ventilator-associated pneumonia: multicenter randomized pilot study

Abstract

INTRODUCTION: Ventilator-associated pneumonia (VAP) is the one of nosocomial infections in intensive care units. VAP can result in prolonged duration of hospitalization and invasive mechanical ventilation (MV) that is associated with attributive mortality. OBJECTIVE: The aim of our pilot multicenter randomized study was to assess effect of the multizonal decontamination of upper airway including subglottic space on the VAP incidence and time of onset, as well as colonization upper airway and clinical outcomes. MATERIALS AND METHODS: Sixty patients requiring the prolonged MV were included in the prospective study. All participants were randomized into three groups: the control, the local antiseptic (LA) and the bacteriophage (BP). All patients were managed using similar VAP protective bundle. Infection-related ventilator-associated complications (IVAC) were registered based on clinical, laboratory, and instrumental examination. Diagnosis of VAP was confirmed if CPIS was ≥ 6 points. RESULTS: A total incidence of IVAC did nоt differ between groups: 15 (75 %), 14 (70 %), and 17 (85 %) cases in the control, LA, and BP groups, respectively. The VAP incidence was lower in the LA and BP groups compared with the controls: 3 (15 %) and 3 (15 %) vs 10 (50 %) cases (χ2 = 8.35; p = 0.015). The overall mortality was 30 % and did not differ between the groups. Multi-selective decontamination resulted in a trend to increased ventilator-associated tracheobronchitis incidence in the BP group and to silent colonization in both LA and BP groups (p = 0.07). No differences in the duration of MV, ICU and hospital stay were observed. CONCLUSIONS: The combined multizonal upper airway decontamination involving subglottic space is associated with a reduction of the VAP incidence but did not change the overall IVAC rate. Multizonal decontamination based on subglottic bacteriophage instillation might have a potential to influence the microbial heterogeneity of upper airways.