Minder beademingspneumonieën door orale decontaminatie met chloorhexidine; gerandomiseerde trial

To determine the effect of oral decontamination with either chlorhexidine (CHX, 2) or the combination chlorhexidine-colistin (CHX-COL, 2-2) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients.

Design

Double blind, placebo-controlled, multicentre, randomised trial.

Methods

Consecutive ICU patients needing at least 48 h of mechanical ventilation were enrolled in a randomized trial with 3 arms: CHX, CHX-COL, and placebo (PLAC). The trial medication was administered in the oral cavity every 6 h. Oropharyngeal swabs were obtained daily and analysed quantitatively for Gram-positive and Gram-negative microorganisms. Endotracheal colonisation was monitored twice weekly. Ventilator-associated pneumonia was diagnosed on the basis of a combination of clinical, radiological and microbiological criteria.

Results

Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX-COL. Baseline characteristics in the three groups were comparable. The daily risk of ventilator-associated pneumonia was reduced in both treatment groups compared to PLAC: 65 (HR = 0.352; 95 CI: 0.160-0.791; p = 0.012) for CHX and 55 (HR = 0.454; 95 CI: 0.224-0.925; p = 0.030) for CHX-COL. CHX-COL provided a significant reduction in oropharyngeal colonisation with both Gram-negative and Gram-positive microorganisms, whereas CHX significantly affected only colonisation with Gram-positive microorganisms. There were no differences in the duration of mechanical ventilation, ICU-stay or ICU-survival.

Conclusion

Oral decontamination of the oropharyngeal cavity with chlorhexidine or the combination chlorhexidine-colistin reduced the incidence and the time to onset of ventilator-associated pneumonia.

Ned Tijdschr Geneeskd. 2008;152:752-9