Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis.
Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis.
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用洗涤酰胺对口腔去污染对医院肺炎发病率的影响：一项荟萃分析。
DOI：
10.1186/cc4837
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发表时间：
2006-02
期刊：
影响因子：
15.1
通讯作者：
El Solh, Ali A.
中科院分区：
文献类型：
--
作者：
Pineda, Lilibeth A.;Saliba, Ranime G.;El Solh, Ali A.
医院获得性肺炎是医院内发病率和死亡率的重要原因。口腔护理干预在减少医院获得性肺炎的发生方面具有很大的潜力。使用局部抗菌剂的研究结果好坏参半。我们假设使用洗必泰进行口腔去污可以降低需要机械通气患者的医院获得性肺炎的发生率。本研究是一项随机对照试验的荟萃分析，旨在评估洗必泰对医院获得性肺炎发生率的影响。数据来源为Medline、EMBASE、科克伦图书馆、相关原始文献和综述文献的引文综述以及与专家线人的联系。在筛选的1，251篇文章中，确定了4项随机对照试验，共纳入1，202例患者。描述性和结局数据由两名评价者独立提取。主要观察指标为医院获得性肺炎的发生率和死亡率。采用随机效应模型。对照组的院内获得性肺炎发生率为7%（41/615），而治疗组为4%（24/587）。革兰氏阴性菌占总分离株的78%，铜绿假单胞菌是最常见的病原体，无论提供的干预措施。两组的机械通气时间和重症监护室住院时间相似。总体而言，使用氯己定进行口腔去污不会影响医院获得性肺炎的发生率（比值比为0.42; 95%置信区间0.16-1.06）或死亡率（比值比0.77，95%置信区间0.28-2.11）。使用洗必泰进行口腔消毒并没有显著降低接受机械通气的患者的医院获得性肺炎的发生率，也没有改变死亡率。缺乏益处可能反映了在这一领域进行的研究很少。未来的试验应侧重于机械和药物干预的组合策略。
Nosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation. This study is a meta-analysis of randomized controlled trials assessing the effect of chlorhexidine on the incidence of nosocomial pneumonia. Data sources were Medline, EMBASE, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Out of 1,251 articles screened, 4 randomized, controlled trials were identified that included a total of 1,202 patients. Descriptive and outcome data were extracted by two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, and mortality. A random effects model was used. The incidence of nosocomial pneumonia in the control group was 7% (41 out of 615) compared to 4% (24 out of 587) in the treatment group. Gram-negative bacteria accounted for 78% of the total isolates, with Pseudomonas aeruginosa being the most frequently isolated pathogen irrespective of the intervention provided. Duration of mechanical ventilation and intensive care unit length of stay were comparable between the two groups. Overall, the use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia (odds ratio of 0.42; 95% confidence interval 0.16–1.06) or the mortality rate (odds ratio 0.77, 95% confidence interval 0.28–2.11). The use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate. The lack of benefit may reflect the few studies conducted in this area. Future trials should focus on a combination strategy of mechanical and pharmacological interventions.
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影响因子：
120.7
作者：
Jüni, P;Witschi, A;Egger, M
通讯作者：
Egger, M
DOI：
10.1164/ajrccm.154.5.8912745
发表时间：
1996-11-01
影响因子：
24.7
作者：
Bonten, MJM;Bergmans, DCJJ;Gaillard, CA
通讯作者：
Gaillard, CA
DOI：
10.1164/ajrccm.156.5.96-04076
发表时间：
1997-11-01
影响因子：
24.7
作者：
GarrousteOrgeas, M;Chevret, S;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
2.8
作者：
Grap, MJ;Munro, CL;Ward, KR
通讯作者：
Ward, KR
影响因子：
9.6
作者：
El-Solh, AA;Pietrantoni, C;Berbary, E
通讯作者：
Berbary, E