Oral topical decontamination for preventing ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials

Journal of Hospital Infection

Volumn 84, Issue 4, 2013, Pages 283-293

  Li, J ^a,b   Xie, D ^a   Li, A ^c   Yue, J ^a  

^a SICHUAN UNIVERSITY   (China)

^b SICHUAN UNIVERSITY   (China)

^c RUSH UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

Systematic review; Topical decontamination; Ventilator associated pneumonia

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT; ISEGANAN;

ANTIBIOTIC THERAPY; ARTIFICIAL VENTILATION; DISINFECTION; ENDOTRACHEAL TUBE; HUMAN; INCIDENCE; INTENSIVE CARE; LENGTH OF STAY; META ANALYSIS; MORTALITY; MOUTH CAVITY; MOUTH HYGIENE; NASOGASTRIC TUBE; ORAL DECONTAMINATION; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; STRESS ULCER; SYSTEMATIC REVIEW; TREATMENT DURATION; VENTILATED PATIENT; VENTILATOR ASSOCIATED PNEUMONIA;

SYSTEMATIC REVIEW; TOPICAL DECONTAMINATION; VENTILATOR-ASSOCIATED PNEUMONIA;

ANTI-INFECTIVE AGENTS, LOCAL; DECONTAMINATION; HUMANS; INCIDENCE; MOUTH; PNEUMONIA, VENTILATOR-ASSOCIATED; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SURVIVAL ANALYSIS; TREATMENT OUTCOME;

EID: 84880605069     PISSN: 01956701     EISSN: 15322939     Source Type: Journal    
DOI: 10.1016/j.jhin.2013.04.012     Document Type: Review

References (49)

1. Edwards J.R., Peterson K.D., Mu Y., et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009, 37:783-805.
2. Safdar N., Dezfulian C., Collard H.R., Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005, 33:2184-2193.
3. Collard H.R., Saint S., Matthay M.A. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003, 138:494-501.
4. Cook D.J., Kollef M.H. Risk factors for ICU-acquired pneumonia. JAm Med Assoc 1998, 279:1605-1606.
5. Estes R.J., Meduri G.U. The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonisation and airway inoculation. Intensive Care Med 1995, 21:365-383.
6. Torres A., El-Ebiary M., González J., et al. Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation. Am Rev Respir Dis 1993, 148:352-357.
7. Johanson W.G., Pierce A.K., Sanford J.P., Thomas G.D. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972, 77:701-706.
8. Sole M.L., Poalillo F.E., Byers J.F., Ludy J.E. Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study. Am J Crit Care 2002, 11:141-149.
9. Azoulay E., Timsit J.F., Tafflet M., et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. CHEST 2006, 129:110-117.
10. Coleman P. Improving oral health care for the frail elderly: a review of widespread problems and best practices. Geriatric Nursing 2002, 23:189-199.
11. Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000, 21:381-386.
12. Genuit T.B.G., Napolitano L.M., McCarter R.J., Roghman M.C. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect (Larchmt) 2001, 2:5-18.
13. Mori H., Hirasawa H., Oda S., Shiga H., Mastuda K., Nakamura M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 2006, 32:230-236.
14. Laggner A.N., Tryba M., Georgopoulos A., et al. Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate?. Wiener Klin Wochenschr 1994, 106:15-19.
15. Houston S., Hougland P., Anderson J.J., LaRocco M., Kennedy V., Gentry L.O. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002, 11:567-570.
16. Chan E.Y., Ruest A., Meade M.O., Cook D.J. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007, 334:889-893.
17. Pileggi C., Bianco A., Flotta D., Nobile C.G.A., Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care 2011, 15:R115.
18. Van de Vyver K, Labeau S, Brusselaers N, Vogelaers D, Blot S. Impact of antiseptic based oral care on rates of ventilator-associated pneumonia in intensive care unit patients: a meta-analysis. 20th European Congress of Clinical Microbiology and Infectious Diseases, Abstracts; 2010.
19. Chlebicki M.P., Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007, 35:595-602.
20. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editors. Cochrane handbook for systematic reviews of interventions, version 5.10 (updated March 2011). The Cochrane Collaboration, 2011. Available from http://www.cochrane-handbook.org.
21. Higgins JPT, Altman DG, Sterne JAC, editors. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from http://www.cochrane-handbook.org.
22. Wu T.X., Liu G.J. The concepts, design, practice and report of allocation concealment and blinding (in Chinese). Chin J Evid Based Med 2007, 7:222-225.
23. Higgins J.P.T., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
24. Rodriguez-Roldan J.M., Altuna-Cuesta A., Lopez A., et al. Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 1990, 18:1239-1242.
25. Abele-Horn M., Dauber A., Bauernfeind A., et al. Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Med 1997, 23:187-195.
26. Fourrier F., Cau-Pottier E., Boutigny H., Roussel-Delvallez M., Jourdain M., Chopin C. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 2000, 26:1239-1247.
27. Bergmans D.C.J.J., Bonten M.J.M., Gaillard C.A., et al. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Resp Crit Care Med 2001, 164:382-388.
28. Chua J.V.D.E., Sison C.M.C., Berba R.P. The efficacy of povidone-iodine oral rinse in preventing ventilator-associated pneumonia: a randomized, double-blind, placebo-controlled (VAPOR) trial: preliminary report. Philipp J Microbiol Infect Dis 2004, 33:153-161.
29. Fourrier F., Dubois D., Pronnier P., et al. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005, 33:1728-1735.
30. Bopp M., Darby M., Loftin K.C., Broscious S. Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study. JDental Hyg 2006, 80:9-21.
31. Koeman M., Van Der Ven A.J.A.M., Hak E., et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006, 173:1348-1355.
32. Kollef M., Pittet D., Garcia M.S., et al. Arandomized double-blind trial of iseganan in prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006, 173:91-97.
33. Seguin P., Tanguy M., Laviolle B., Tirel O., Malledant Y. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma. Crit Care Med 2006, 34:1514-1519.
34. Tantipong H., Morkchareonpong C., Jaiyindee S., Thamlikitkul V. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2008, 29:131-136.
35. Bellissimo-Rodrigues F., Bellissimo-Rodrigues W.T., Viana J.M., et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients. Infect Control Hosp Epidemiol 2009, 30:952-958.
36. Panchabhai T.S., Dangayach N.S., Krishnan A., Kothari V.M., Karnad D.R. Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009, 135:1150-1156.
37. Scannapieco F., Yu J., Raghavendran K., et al. Arandomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Crit Care 2009, 13:R117.
38. Berry A.M., Davidson P.M., Masters J., Rolls K., Ollerton R. Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial. Int J Nurs Stud 2011, 48:681-688.
39. Grap M.J., Munro C.L., Hamilton V.A., Elswick R.K., Sessler C.N., Ward K.R. Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart Lung 2011, 40:e115-e122.
40. Aerdts S.J.A., Clasener H.A.L., Blair P.H.B. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. Selective Decontamination of the Digestive Tract Trialists' Collaborative Group. BMJ 1993, 307:525-532.
41. Hurley J.C. Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection?. Antimicrob Agents Chemother 1995, 39:941-947.
42. Nathens A.B., Marshall J.C. Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Archs Surg 1999, 134:170-176.
43. Silvestri L., van Saene H.K., Milanese M., Gregori D., Gullo A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials. JHosp Infect 2007, 65:187-203.
44. Silvestri L., Van Saene H.K.F., Casarin A., Berlot G., Gullo A. Impact of selective decontamination of the digestive tract on carriage and infection due to Gram-negative and Gram-positive bacteria: a systematic review of randomised controlled trials. Anaesth Intensive Care 2008, 36:324-338.
45. D'Amico R., Pifferi S., Torri V., Brazzi L., Parmelli E., Liberati A. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database of Syst Rev 2009, (4). DOI: http://dx.doi.org/10.1002/14651858.CD000022.pub3.
46. Labeau S.O., Van de Vyver K., Brusselaers N., Vogelaers D., Blot S.I. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011, 11:845-854.
47. Niederman M., Craven D., Bonten M., et al. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Crit Care Med 2005, 171:388-416.
48. Dickersin K. The existence of publication bias and risk factors for its occurrence. JAMA 1990, 263:1385-1389.
49. Horan T.C., Andrus M., Dudeck M.A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008, 36:309-332.