Abstract
BackgroundTopical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota.MethodsThis randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data.ResultsAfter irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota.ConclusionsTopical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota.Trial registrationUniversity Hospitals Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000028307. Registered 1 September 2017.
Highlights
Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation
The concentration of streptococci, methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans were estimated based on real-time polymerase chain reaction (PCR) data
After the initial heat denaturation at 98 °C for 2 min, the target DNA was amplified by carrying out 40 cycles of two steps: Changes in the balance of the oral microbiota in the intervention group The number of streptococci, MRSA, S. pneumoniae, P. aeruginosa, P. gingivalis, and C. albicans was decreased at 1–3 h after oral care in the intervention group (Fig. 4)
Summary
Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. It is not approved for mucosal application in Japan. Ventilator-associated pneumonia (VAP) is an airway infection developing more than 48 h after intubation that affects 8–28% of patients requiring mechanical ventilation. VAP is a major complication in the intensive care unit that has been reported to contribute to higher mortality rates and longer hospital stays [1,2,3,4]. Despite its effectiveness in preventing VAP, 0.12% chlorhexidine is not approved for mucosal application in Japan. Oral care is not included in the Japanese Society of Intensive Care Medicine (JSICM) VAP Bundle [6]
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