Research

A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients

Frank A Scannapieco¹ , Jihnhee Yu² , Krishnan Raghavendran^3,4,7 , Angela Vacanti¹ , Susan I Owens⁵ , Kenneth Wood⁵ and Joseph M Mylotte⁶

¹Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main St. Buffalo, NY 14214, USA

²Department of Biostatistics, School of Public Health and Health Professions, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA

³Department of Surgery and Anesthesiology, School of Medicine and Biomedical Sciences, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA

⁴Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA

⁵Frontier Science and Technology Research Foundation, 4033 Maple Road, Amherst, NY 14266, USA

⁶Department of Medicine, School of Medicine and Biomedical Sciences, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA

⁷Current address: Department of Surgery, University of Michigan, 1C421 University Hospital, SPC 50331500 E. Medical Center Drive, Ann Arbor, MI 48109, USA

author email corresponding author email

Critical Care 2009, 13:R117doi:10.1186/cc7967

Published:	15 July 2009

See related commentary by Derde and Bonten, http://ccforum.com/content/13/5/183

Abstract

Introduction

Dental plaque biofilms are colonized by respiratory pathogens in mechanically-ventilated intensive care unit patients. Thus, improvements in oral hygiene in these patients may prevent ventilator-associated pneumonia. The goal of this study was to determine the minimum frequency (once or twice a day) for 0.12% chlorhexidine gluconate application necessary to reduce oral colonization by pathogens in 175 intubated patients in a trauma intensive care unit.

Methods

A randomized, double-blind, placebo-controlled clinical trial tested oral topical 0.12% chlorhexidine gluconate or placebo (vehicle alone), applied once or twice a day by staff nurses. Quantitation of colonization of the oral cavity by respiratory pathogens (teeth/denture/buccal mucosa) was measured.

Results

Subjects were recruited from 1 March, 2004 until 30 November, 2007. While 175 subjects were randomized, microbiologic baseline data was available for 146 subjects, with 115 subjects having full outcome assessment after at least 48 hours. Chlorhexidine reduced the number of Staphylococcus aureus, but not the total number of enterics, Pseudomonas or Acinetobacter in the dental plaque of test subjects. A non-significant reduction in pneumonia rate was noted in groups treated with chlorhexidine compared with the placebo group (OR = 0.54, 95% CI: 0.23 to 1.25, P = 0.15). No evidence for resistance to chlorhexidine was noted, and no adverse events were observed. No differences were noted in microbiologic or clinical outcomes between treatment arms.

Conclusions

While decontamination of the oral cavity with chlorhexidine did not reduce the total number of potential respiratory pathogens, it did reduce the number of S. aureus in dental plaque of trauma intensive care patients.

Trial Registration

clinicaltrials.gov NCT00123123.