Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients
Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients
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DOI：
10.1086/605722
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发表时间：
2009-10-01
影响因子：
4.5
通讯作者：
Martinez, Roberto
中科院分区：
文献类型：
--
作者：
Bellissimo-Rodrigues, Fernando;Bellissimo-Rodrigues, Wanessa Teixeira;Martinez, Roberto
OBJECTIVE.评价口服0.12%洗必泰溶液预防重症监护病房（ICU）患者呼吸道感染的有效性。研究设计为双盲、随机、安慰剂对照试验。该研究在公立大学三级医院的ICU中进行。研究参与者包括194名入住ICU的患者，预期住院时间超过48小时，随机分为2组：接受洗必泰（n = 98）和接受安慰剂（n = 96）。在患者入住ICU期间，每天用氯己定或安慰剂进行3次口腔冲洗。前瞻性收集临床数据。两组显示出相似的基线临床特征。实验组和对照组呼吸道感染的总体发生率（RR，1.0 [95%置信区间[CI]，0.63-1.60]）和每1,000个呼吸机日的呼吸机相关肺炎发生率相似（22.6 vs 22.3; P = 0.95）。无呼吸道感染生存时间（7.8 vs 6.9天; P = 0.61）、机械通气持续时间（11.1 vs 11.0天; P = 0.61）和住院时间（9.7 vs 10.4天; P = 0.67）在氯己定组和安慰剂组之间没有差异。然而，洗必泰组患者在ICU入院和首次呼吸道感染发作之间的时间间隔更长（11.3 vs 7.6天; P = 0.05）。两组患者在ICU的存活率相似（RR，1.08 [95% CI，0.72-1.63]）。口服0.12%的洗必泰溶液不能预防ICU患者的呼吸道感染，尽管它可能延缓其发作。
OBJECTIVE. To evaluate the effectiveness of the oral application of a 0.12% solution of chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.DESIGN. The study design was a double-blind, randomized, placebo-controlled trial.SETTING. The study was performed in an ICU in a tertiary care hospital at a public university.PATIENTS. Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received chlorhexidine (n = 98) and those who received a placebo (n = 96).INTERVENTION. Oral rinses with chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.RESULTS. Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the chlorhexidine and placebo groups. However, patients in the chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).CONCLUSION. Oral application of a 0.12% solution of chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.