The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study

被引：30
作者：
Cabov, Tomislav [1 ]
Macan, Darko [2 ]
Husedzinovic, Ino [3 ]
Skrlin-Subic, Jasenka [4 ]
Bosnjak, Danica [3 ]
Sestan-Crnek, Sandra [4 ]
Peric, Berislav [2 ]
Kovac, Zoran [5 ]
Golubovic, Vesna [6 ]
机构：
[1] Univ Rijeka, Sch Med, Clin Hosp Ctr Rijeka, Dept Oral & Maxillofacial Surg, Rijeka 51000, Croatia
[2] Univ Zagreb, Sch Dent Med, Univ Hosp Dubrava, Dept Oral & Maxillofacial Surg, Zagreb 41000, Croatia
[3] Univ Zagreb, Sch Dent Med, Univ Hosp Dubrava, Dept Anesthesiol & Intens Care Med, Zagreb 41000, Croatia
[4] Univ Hosp Dubrava, Dept Clin Microbiol & Hosp Infect, Zagreb, Croatia
[5] Clin Hosp Ctr Rijeka, Dept Dent, Rijeka, Croatia
[6] Univ Rijeka, Sch Med, Dept Anesthesiol & Intens Care Med, Rijeka 51000, Croatia
来源：
WIENER KLINISCHE WOCHENSCHRIFT | 2010年 / 122卷 / 13-14期
关键词：
Nosocomial infection; dental plaque; oral decontamination; chlorhexidine; intensive-care patients; VENTILATOR-ASSOCIATED PNEUMONIA; PLAQUE ANTISEPTIC DECONTAMINATION; CRITICALLY-ILL; DENTAL PLAQUE; DOUBLE-BLIND; DIGESTIVE-TRACT; SELECTIVE DECONTAMINATION; CONTROLLED-TRIAL; HEART-SURGERY; METAANALYSIS;
D O I：
10.1007/s00508-010-1397-y
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
OBJECTIVES: To evaluate the impact of oral health on the evolution of nosocomial infections and to document the effects of oral antiseptic decontamination on oral health and on the rate of nosocomial infections in patients in a surgical intensive-care unit (ICU). DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Surgical ICU in University Hospital Dubrava. PATIENTS: The study included 60 nonedentulous patients consecutively admitted to the surgical ICU and requiring a minimum stay of three days. MAIN OUTCOME MEASURES: After randomization, the treatment group underwent antiseptic decontamination of dental plaque and the oral mucosa with chlorhexidine gel. The control group was treated with placebo gel. Dental status was assessed using a caries-absent-occluded (CAO) score, and the amount of plaque was assessed using a semi-quantitative score. Samples of dental plaque, oral mucosa and nasal and tracheal aspirates were collected for bacterial culture, and nosocomial infections were assessed. RESULTS: The plaque score significantly increased in the control group and decreased in the treated patients. Patients who developed a nosocomial infection had higher plaque scores on admission and during their ICU stay. The control group showed increased colonization by aerobic pathogens throughout their ICU stay and developed nosocomial infections (26.7%) significantly more often than the treated patients (6.7%); the control group also stayed longer in the ICU (5.1 +/- 1.6 vs. 6.8 +/- 3.5 days, P = 0.019). Furthermore, a trend in reduction of mortality was noted in the treated group (3.3% vs. 10%). CONCLUSIONS: Among surgical ICU patients, poor oral health had a significant positive correlation with bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU stay, and mortality in these patients.
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收藏
页码：397 / 404
页数：8
相关论文
共 29 条
[1]   Prevention of ventilator-associated pneumonia by oral decontamination - A prospective, randomized, double-blind, placebo-controlled study [J].
Bergmans, DCJJ ;
Bonten, MJM ;
Gaillard, CA ;
Paling, JC ;
van der Geest, S ;
van Tiel, FH ;
Beysens, AJ ;
de Leeuw, PW ;
Stobberingh, EE .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2001, 164 (03) :382-388
[2]   Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis [J].
Chan, Ee Yuee ;
Ruest, Annie ;
Meade, Maureen O. ;
Cook, Deborah J. .
BMJ-BRITISH MEDICAL JOURNAL, 2007, 334 (7599) :889-893
[3]   Ventilator-associated pneumonia [J].
Chastre, J ;
Fagon, JY .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 165 (07) :867-903
[4]   Topical chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis [J].
Chlebicki, Madej Piotr ;
Safdar, Nasia .
CRITICAL CARE MEDICINE, 2007, 35 (02) :595-602
[5]   Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial [J].
de Jonge, E ;
Schultz, MJ ;
Spanjaard, L ;
Bossuyt, PMM ;
Vroom, MB ;
Dankert, J ;
Kesecioglu, J .
LANCET, 2003, 362 (9389) :1011-1016
[6]   Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract -: A randomized, placebo-controlled, double-blind trial [J].
de La Cal, MA ;
Cerdá, E ;
García-Hierro, P ;
van Saene, HKF ;
Gómez-Santos, D ;
Negro, E ;
Lorente, JA .
ANNALS OF SURGERY, 2005, 241 (03) :424-430
[7]   Decontamination of the Digestive Tract and Oropharynx in ICU Patients [J].
de Smet, A. M. G. A. ;
Kluytmans, J. A. J. W. ;
Cooper, B. S. ;
Mascini, E. M. ;
Benus, R. F. J. ;
van der Werf, T. S. ;
van der Hoeven, J. G. ;
Pickkers, P. ;
Bogaers-Hofman, D. ;
van der Meer, N. J. M. ;
Bernards, A. T. ;
Kuijper, E. J. ;
Joore, J. C. A. ;
Hall, M. A. Leverstein-van ;
Bindels, A. J. G. H. ;
Jansz, A. R. ;
Wesselink, R. M. J. ;
de Jongh, B. M. ;
Dennesen, P. J. W. ;
van Asselt, G. J. ;
Velde, L. F. te ;
Frenay, I. H. M. E. ;
Kaasjager, K. ;
Bosch, F. H. ;
van Iterson, M. ;
Thijsen, S. F. T. ;
Kluge, G. H. ;
Pauw, W. ;
de Vries, J. W. ;
Kaan, J. A. ;
Arends, J. P. ;
Aarts, L. P. H. J. ;
Sturm, P. D. J. ;
Harinck, H. I. J. ;
Voss, A. ;
Uijtendaal, E. V. ;
Blok, H. E. M. ;
Groen, E. S. Thieme ;
Pouw, M. E. ;
Kalkman, C. J. ;
Bonten, M. J. M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (01) :20-31
[8]   Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery [J].
DeRiso, A ;
Ladowski, JS ;
Dillon, TA ;
Justice, JW ;
Peterson, AC .
CHEST, 1996, 109 (06) :1556-1561
[9]  
FIDDIANGREEN RG, 1991, CRIT CARE MED, V19, P763
[10]   Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients [J].
Fourrier, F ;
Cau-Pottier, E ;
Boutigny, H ;
Roussel-Delvallez, M ;
Jourdain, M ;
Chopin, C .
INTENSIVE CARE MEDICINE, 2000, 26 (09) :1239-1247
123