Jiménez MV, López GLA, Athié GJM

Language: Spanish
References: 17
Page: 133-138
PDF size: 145.58 Kb.

ABSTRACT

Background: Pre-surgical oral hygiene (POH) with tooth brushing has been established to prevent infectious complications. The need of an additional cleansing with chlorhexidine is questionable. Objective: To establish the level of pharyngeal bacterial colonization according to compliance with POH and the additional impact of a chlorhexidine rinse. Methods: Study with patients 18 years and older scheduled for surgery. Two phases: first, we evaluated the level of colonization (mild-moderate-severe) according to compliance or not with the POH, and second, to a randomly assigned rinse (or not) with 15 mL of chlorhexidine (0.12%). The presence of pathogenic agents was analyzed. Results: 48/60 (80%) did not comply with the POH. All had moderate to high colonization, but compliers had a lower proportion of high colonization (16.7 versus 33.3%, p = 0.23). After cleansing with chlorhexidine (30 patients), 1/6 (16%) with POH continued with high colonization, the rest fell to moderate; 20% (5/24) without POH continued with high colonization, 70% (17/24) fell from high to moderate and two (8%) from high to mild; one (4%) with moderate pre-chlorhexidine colonization decreased to mild. Only six patients without POH (12.6%) had S. aureus or S. pneumoniae isolated. Chlorhexidine reduced colonization from high to moderate in three with S. aureus, in the other, it remained high. Chlorhexidine reduced colonization from high to moderate in one of the two patients with S. pneumoniae. Conclusion: Compliance with POH reduces pharyngeal colonization, especially of pathogenic bacteria. The addition of a rinse with chlorhexidine can increase this protection.

REFERENCES

1. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011; 11 (11): 845-854.

2. Quintas V, Prada-López I, Prados-Frutos JC, Tomás I. In situ antimicrobial activity on oral biofilm: essential oils vs. 0.2% chlorhexidine. Clin Oral Investig. 2015; 19 (1): 97-107.

3. Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002; 50 (3): 430-433.

4. Marino PJ, Wise MP, Smith A, Marchesi JR, Riggio MP, Lewis MAO et al. Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients. J Crit Care. 2017; 39: 149-155.

5. Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, tooth brushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care. 2009; 18 (5): 428-437; quiz 438.

6. McGovern Murphy F, Raymond M, Menard PA, Bejar-Ardiles KR, Carignan A, Lesur O. Ventilator associated pneumonia and endotracheal tube repositioning: an underrated risk factor. Am J Infect Control. 2014; 42 (12): 1328-1330.

7. Ohara-Nemoto Y, Haraga H, Kimura S, Nemoto TK. Occurrence of staphylococci in the oral cavities of healthy adults and nasal oral trafficking of the bacteria. J Med Microbiol. 2008; 57 (Pt 1): 95-99.

8. Rello J, Lode H, Cornaglia G, Masterton R; VAP Care Bundle Contributors. A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Med. 2010; 36 (5): 773-780.

9. Jaimes F, De La Rosa G, Gómez E, Múnera P, Ramírez J, Castrillón S. Incidence and risk factors for ventilator-associated pneumonia in a developing country: where is the difference? Respir Med. 2007; 101 (4): 762-767.

10. Santos GOD, Milanesi FC, Greggianin BF, Fernandes MI, Oppermann RV, Weidlich P. Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference. Braz Oral Res. 2017; 31: e32.

11. DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and non prophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996; 109 (6): 1556-1561.

12. Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014; 174 (5): 751-761.

13. Valdés C, Tomás I, Alvarez M, Limeres J, Medina J, Diz P. The incidence of bacteraemia associated with tracheal intubation. Anaesthesia. 2008; 63 (6): 588-592.

14. DeLuca LA Jr, Walsh P, Davidson DD Jr, Stoneking LR, Yang LM, Grall KJ et al. Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. Am J Infect Control. 2017; 45 (2): 151-157.

15. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013; 13 (8): 665-671.

16. Righi E, Aggazzotti G, Ferrari E, Giovanardi C, Busani S, Rinaldi L et al. Trends in ventilator-associated pneumonia: impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit. Am J Infect Control. 2014; 42 (12): 1312-1316.

17. Okgün Alcan A, Demir-Korkmaz F, Uyar M. Prevention of ventilator-associated pneumonia: Use of the care bundle approach. Am J Infect Control. 2016; 44 (10): e173-e176.