Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.
Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.
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DOI：
10.1007/s00134-018-5171-3
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发表时间：
2018-07
影响因子：
38.9
通讯作者：
Blot S
中科院分区：
文献类型：
--
作者：
Deschepper M;Waegeman W;Eeckloo K;Vogelaers D;Blot S
洗必泰口腔护理广泛应用于危重和非危重住院患者，以维持口腔健康。我们调查了氯己定口腔护理对一般住院人群死亡率的影响。在这项单中心、回顾性、全院观察性队列研究中，我们纳入了成年住院患者（2012-2014 年）。通过逻辑回归分析评估与氯己定口腔护理相关的死亡率。 300 毫克的累积阈值剂量作为氯己定暴露的二分代理。我们根据人口统计数据、诊断类别和四种类别（轻微、中等、严重和极端）的死亡风险进行了调整。该研究队列包括 82,274 名患者，其中 11,133 名 (14%) 接受洗必太口腔护理。低水平接触氯己定口腔护理剂（≤ 300 mg）与死亡风险增加相关[比值比 (OR) 2.61； 95% 置信区间 (CI) 2.32–2.92]。这种关联在死亡风险较低的患者中更为明显：轻度/中度风险的 OR 5.50 (95% CI 4.51–6.71)，重大风险的 OR 2.33 (95% CI 1.96–2.78)，极端死亡风险的 OR 1.13 (95% CI 0.90–1.41) 不显着。对于高浓度暴露（> 300 mg）也进行了类似的观察。在通气和非通气 ICU 患者中未观察到有害影响。未接受机械通气且未入住 ICU 的患者死亡风险增加。调整后导致 1 例死亡病例需要接触的患者数量为 47.1 例（95% CI 45.2-49.1）。这些数据反对在住院患者中不加区别地广泛使用洗必泰口腔护理，因为在特定人群中缺乏经过证实的益处。本文的在线版本 (10.1007/s00134-018-5171-3) 包含补充材料，可供授权用户使用。
Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. In this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012–2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme). The study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32–2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51–6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96–2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90–1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2–49.1). These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations. The online version of this article (10.1007/s00134-018-5171-3) contains supplementary material, which is available to authorized users.
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影响因子：
39
作者：
Klompas, Michael;Speck, Kathleen;Berenholtz, Sean M.
通讯作者：
Berenholtz, Sean M.
影响因子：
0.2
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影响因子：
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作者：
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2.9
作者：
Hollaar V;van der Maarel-Wierink C;van der Putten GJ;de Swart B;de Baat C
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de Baat C