sharon sanders
Editor-in-Chief & President
The Lancet Infectious Diseases 2006; 6:472
DOI:10.1016/S1473-3099(06)70542-4
Chlorhexidine could cut risk of pneumonia in intensive care Katherine Nightingale
Research in the Netherlands suggests that application of the antiseptic chlorhexidine to the mouths of patients in intensive care units could cut rates of ventilator associated pneumonia (VAP). VAP is the most frequently occurring hospital-acquired infection associated with both increased morbidity and mortality.
In this study, from the University Medical Centre Utrecht, a randomised selection of 385 ventilator-assisted patients were given either a placebo, a 2% preparation of the antiseptic chlorhexidine, or a combination of 2% chlorhexidine and 2% colistin, an antimicrobial peptide. Antimicrobials were applied to the mouths of patients in a vaseline paste four times a day. Swabs were taken between applications to detect colonising bacteria, and patients were monitored for signs of VAP.
Rates of VAP were found to be 18% in the placebo group, 10% in the chlorhexidine group, and 13% in the chlorhexidine/colistin group. In terms of antimicrobial colonisation, the combination of drugs was more effective than chlorhexidine alone, largely because of colistin's better efficacy against Gram-negative bacteria. The use of colistin has been recommended against, however, due to its increasing use as a last-resort treatment against multidrug-resistant Gram-negative bacteria, and the possibility of selection of resistant pathogens.
Mark Wilcox (University of Leeds, UK) comments, ?This is an important finding using a simple, inexpensive intervention. However, there is a need to replicate the results and importantly to determine if the intervention can affect key outcome measures such as duration of mechanical ventilation, intensive care unit stay, or survival, which were not shown in the present study.? But the lead researcher in the study, Mirelle Koeman, cites problems with the particular clinical environment. ?The inability to demonstrate such differences in patient outcome can be attributed to the very low incidence of multi-resistant pathogens, adequate initial empirical treatment of all VAP episodes, and a low VAP incidence in control patients?, she says.
Topical application of antibiotics to the oropharyngeal cavity has been shown to significantly reduce the incidence of VAP. However, the continuous use of antibiotics in this way increases the risk of selection of resistant pathogens, and is not advised. ?This effective, safe, and cheap alternative for antibiotic containing regimes should, in our opinion, be recommended, especially in settings with high levels of antibiotic resistance?, adds Koeman.
DOI:10.1016/S1473-3099(06)70542-4
Chlorhexidine could cut risk of pneumonia in intensive care Katherine Nightingale
Research in the Netherlands suggests that application of the antiseptic chlorhexidine to the mouths of patients in intensive care units could cut rates of ventilator associated pneumonia (VAP). VAP is the most frequently occurring hospital-acquired infection associated with both increased morbidity and mortality.
In this study, from the University Medical Centre Utrecht, a randomised selection of 385 ventilator-assisted patients were given either a placebo, a 2% preparation of the antiseptic chlorhexidine, or a combination of 2% chlorhexidine and 2% colistin, an antimicrobial peptide. Antimicrobials were applied to the mouths of patients in a vaseline paste four times a day. Swabs were taken between applications to detect colonising bacteria, and patients were monitored for signs of VAP.
Rates of VAP were found to be 18% in the placebo group, 10% in the chlorhexidine group, and 13% in the chlorhexidine/colistin group. In terms of antimicrobial colonisation, the combination of drugs was more effective than chlorhexidine alone, largely because of colistin's better efficacy against Gram-negative bacteria. The use of colistin has been recommended against, however, due to its increasing use as a last-resort treatment against multidrug-resistant Gram-negative bacteria, and the possibility of selection of resistant pathogens.
Mark Wilcox (University of Leeds, UK) comments, ?This is an important finding using a simple, inexpensive intervention. However, there is a need to replicate the results and importantly to determine if the intervention can affect key outcome measures such as duration of mechanical ventilation, intensive care unit stay, or survival, which were not shown in the present study.? But the lead researcher in the study, Mirelle Koeman, cites problems with the particular clinical environment. ?The inability to demonstrate such differences in patient outcome can be attributed to the very low incidence of multi-resistant pathogens, adequate initial empirical treatment of all VAP episodes, and a low VAP incidence in control patients?, she says.
Topical application of antibiotics to the oropharyngeal cavity has been shown to significantly reduce the incidence of VAP. However, the continuous use of antibiotics in this way increases the risk of selection of resistant pathogens, and is not advised. ?This effective, safe, and cheap alternative for antibiotic containing regimes should, in our opinion, be recommended, especially in settings with high levels of antibiotic resistance?, adds Koeman.