Oropharyngeal decontamination in intensive care patients: less is not more

Lennie Pg Derde,Marc Jm Bonten

doi:10.1186/cc8013

Abstract

Ventilator-associated pneumonia (VAP) is a common cause of morbidity, antibiotic use, increased length of stay and, possibly, increased mortality in ICU patients. Colonization of the oropharyngeal cavity with potentially pathogenic micro-organisms is instrumental in the pathogenesis of VAP, and selective oropharyngeal decontamination (SOD) with antibiotics (AB-SOD) or antiseptics, such as chlorhexidine gluconate (CHX-SOD), has been associated with reduced incidences of VAP. In a recent issue of Critical Care Scannapieco and colleagues investigated differences in oropharyngeal colonization between mechanically ventilated patients receiving oropharyngeal decontamination with 0.12% CHX-SOD either once or twice daily compared to placebo. CHX-SOD was associated with a reduction in Staphylococcus aureus colonization, but the study was underpowered to demonstrate a reduction in VAP incidence. We urgently need well-designed and adequately powered studies to evaluate the potential benefits of CHX-SOD on patient outcome in ICUs.

Highlights

AB-selective oropharyngeal decontamination (SOD) was associated with reduced incidences of Ventilator-associated pneumonia (VAP) in various studies [4-6], and recently with a better 28-day survival in a large Dutch multi-center study [7]
AB-SOD was associated with reduced incidences of VAP in various studies [4-6], and recently with a better 28-day survival in a large Dutch multi-center study [7]
AB-SOD was effective in improving patient outcome as selective decontamination of the digestive tract (SDD), which combines AB-SOD with intestinal decontamination and 4 days of intravenous cefotaxim

Summary

Introduction

AB-SOD was associated with reduced incidences of VAP in various studies [4-6], and recently with a better 28-day survival in a large Dutch multi-center study [7]. Oropharyngeal decontamination with antibiotics (AB-SOD)) or with topically applied chlorhexidine gluconate (CHX-SOD). Replacing antibiotics with antiseptics for oral decontamination might offer an effective and safe measure for ICU patients, even in settings with high levels of AMRB.

Results

Conclusion