Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit:: A double-blind placebo-controlled multicenter study
Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit:: A double-blind placebo-controlled multicenter study
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DOI：
10.1097/01.ccm.0000171537.03493.b0
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发表时间：
2005-08-01
影响因子：
8.8
通讯作者：
Roussel-Delvallez, M
中科院分区：
文献类型：
--
作者：
Fourrier, F;Dubois, D;Roussel-Delvallez, M
Objective.记录牙龈和牙菌斑抗菌消毒对重症监护病房（ICU）获得性院内细菌感染和呼吸道感染率的影响。前瞻性、多中心、双盲、安慰剂对照疗效研究。六个ICU：三个在大学医院，三个在综合医院。共228名需要气管插管和机械通气的无牙患者，预期住院时间>= 5 days.Interventions：在整个ICU住院期间，每天三次，用0.2%氯己定凝胶或安慰剂凝胶对牙龈和牙菌斑进行抗菌去污。在基线至第28天评估人口统计学和临床特征、器官功能数据（Logistic器官功能障碍评分）、病情严重程度（简化急性生理评分）和牙菌斑状态。每5天对牙菌斑和唾液进行细菌学采样，适当时进行血液、气管抽吸物和支气管肺泡灌洗液培养。主要疗效终点是菌血症、支气管炎和呼吸机相关性肺炎的发生率，以百分比和每1000个ICU日表示。治疗组和安慰剂组之间的所有基线特征相似。安慰剂组的医院感染发生率为17.5%（13.2/1000 ICU日），斑块抗菌消毒组为18.4%（13.3/1000 ICU日）（不显著）。在每台呼吸机或插管天数的呼吸机相关性肺炎发生率、死亡率、住院时间和护理负荷（次要终点）方面没有观察到差异。在第10天，治疗组中阳性牙菌斑培养物的数量显著较低（29%对66%; p <0.05）。在晚发性呼吸机相关性肺炎中发现的高耐药假单胞菌属、不动杆菌属和肠杆菌属，以及先前从牙菌斑中培养的细菌，未被抗菌去污剂根除。无不良反应发生。牙龈和牙菌斑消毒剂去污显着降低了通气患者口咽部需氧病原体的定植。然而，它的功效不足以降低由于多重耐药细菌引起的呼吸道感染的发生率。
Objective. To document the effect of gingival and dental plaque antiseptic decontamination on the rate of nosocomial bacteremias and respiratory infections acquired in the intensive care unit (ICU).Design. Prospective, multicenter, double-blind, placebo-controlled efficacy study.Setting. Six ICUs: three in university hospitals and three in general hospitals.Patients. A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation, with an anticipated length of stay >= 5 days.Interventions: Antiseptic decontamination of gingival and dental plaque with a 0.2% chlorhexidine gel or a placebo gel, three times a day, during the entire ICU stay.Measurements and Main Results., Demographic and clinical characteristics, organ function data (Logistic Organ Dysfunction score), severity of condition (Simplified Acute Physiologic Score), and dental plaque status were assessed at baseline and until 28 days. Bacteriologic sampling of dental plaque and saliva was done every 5 days, and blood, tracheal aspirate, and bronchoalveolar lavage cultures were performed when appropriate. The primary efficacy end point was the incidence of bacteremia, bronchitis, and ventilator-associated pneumonia, expressed as a percentage and per 1000 ICU days. All baseline characteristics were similar between the treated and the placebo groups. The incidence of nosocomial infections was 17.5% (13.2 per 1000 ICU days) in the placebo group and 18.4% (13.3 per 1000 ICU days) in the plaque antiseptic decontamination group (not significant). No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days, mortality, length of stay, and care loads (secondary end points). On day 10, the number of positive dental plaque cultures was significanty lower in the treated group (29% vs. 66%; p < .05). Highly resistant Pseudomonas, Acinetobacter, and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination. No side effect was reported.Conclusions. Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients. However, its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria.