Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study
Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study
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DOI：
10.1186/s12903-020-1043-7
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发表时间：
2020-02-24
期刊：
影响因子：
2.9
通讯作者：
Umeda, Masahiro
中科院分区：
文献类型：
--
作者：
Tsuda, Shoma;Soutome, Sakiko;Umeda, Masahiro
背景0.12%洗必泰已被广泛用于预防机械通气患者的呼吸机相关性肺炎。然而，它在日本没有被批准用于粘膜应用。这项研究的目的是调查局部使用聚维酮碘(I)是否抑制细菌生长，以及(II)是否破坏口腔微生物区系的平衡。方法采用随机对照临床试验方法，对23例在重症监护病房接受机械通气治疗的患者进行研究。将患者随机分为两组：干预组16例，对照组7例。所有患者均接受3%双氧水口腔清洁，然后用自来水冲洗。干预组采用10%聚维酮碘口腔局部涂抹。分别在口腔护理前、口腔护理后即刻、口腔护理后1h、2 h、3h用快速口腔细菌定量系统测定口咽液中细菌总数，采用介电泳法和阻抗测量法。根据实时聚合酶链式反应数据估计口腔护理前、即刻、术后1h和3h的链球菌、耐甲氧西林金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌、牙龈卟啉单胞菌和白色念珠菌的数量。结果对照组口腔冲洗后细菌数量减少，1h后细菌数量再次增加，而干预组在口腔护理后1h(p=0.009)、2h(p=0.001)、3h(p=0.001)细菌浓度明显低于对照组。干预组在口腔护理后3h所有受试菌种的生长均受到抑制，提示聚维酮碘不影响口腔微生物区系的平衡。结论口腔清洁冲洗后局部应用聚维酮碘可抑制机械通气患者口咽液中细菌的生长，但不会破坏口腔微生物区系的平衡。
Background Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota. Methods This randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data. Results After irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota. Conclusions Topical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota.