A Systematic Review of Selective Oropharyngeal Decontamination for the Prevention of Ventilator-associated Pneumonia_West China Medical Journal

Authors：

 LIUWei ¹ , LIYun-wei ¹ , ZUOYan-yan ² ,  KANGYan ²

1. Department of Emergency, the Fourth People's Hospital of Langfang City, Langfang, Hebei 065700, P. R. China;
2. Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

KANGYan, Email: kang_yan_123@163.com

Keywords：

Ventilator-associated pneumonia; Oropharyngeal decontamination; Systematic review; Meta-analysis

DOI：

10.7507/1002-0179.20140563

Video：

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Objective To systematically review the effect of selective oropharyngeal decontamination (SOD) on the prevention of ventilator-associated pneumonia (VAP). Methods We electronically searched PubMed, EMbase, CBM, Wanfang, CNKI and Cochrane Central Register of Controlled Trials from the date of its establishment to September 2013. We also hand-searched some relevant references of included studies. Two independent reviewers screened the studies for inclusion, extracted data, and assessed trial quality. Meta-analysis was performed using the Cochrane Collaboration's RevMan 5.1 software. Results Ten randomized controlled trials involving 2 791 patients were included. Results of meta-analysis showed that, compared with control group, SOD could reduce the incidence of VAP[RR=0.53, 95% CI (0.43, 0.65), P<0.000 01]. No statistical differences between the two groups were found for all cause mortality, average duration of receiving mechanical ventilatory assistance or length of stay in intensive care unit. No severe adverse event related to study participation was identified. Conclusion SOD can reduce the occurrence of VAP effectively and safely. Consequently, it may be considered as a good choice in the prevention of VAP.

Citation： LIUWei, LIYun-wei, ZUOYan-yan, KANGYan. A Systematic Review of Selective Oropharyngeal Decontamination for the Prevention of Ventilator-associated Pneumonia. West China Medical Journal, 2014, 29(10): 1849-1854. doi: 10.7507/1002-0179.20140563 Copy

1.	Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States[J]. Crit Care Med, 1999, 27(5):887-892.
2.	Chastre J, Jy F. Ventilator-associated pneumonia[J]. Am J Respir Crit Care Med, 2002, 165(7):867-903.
3.	Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review[J]. Crit Care Med, 2005, 33(10):2184-2193.
4.	van der Waaij D, Berghuis-de Vries JM, Lekkerkerk-van der Wees JEC. Colonization resistance of the digestive tract in conventional and antibiotic-treated mice[J]. J Hyg (Lond), 1971, 69(3):405-411.
5.	Stoutenbeek CP, van Saene HK, Miranda DR, et al. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients[J]. Intensive Care Med, 1984, 10(4):185-192.
6.	De La Cal MA, Cerdá E, García-Hierro P, et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract:a randomized, placebo-controlled, double-blind trial[J]. Ann Surg, 2005, 241(3):424-430.
7.	Liberati A, D'amico R, Torri V, et al. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care[J]. Cochrane Database Syst Rev, 2004(1):CD000022.
8.	Vandenbroucke-Grauls CM, Vandenbroucke JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit[J]. Lancet, 1991, 338(8771):859-862.
9.	Kollef MH. Opinion:the clinical use of selective digestive decontamination[J]. Crit Care, 2000, 4(6):327-332.
10.	Gastinne H, Wolff M, Delatour F, et al. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract[J]. N Engl J Med, 1992, 326(9):594-599.
11.	Bastin AJ, Ryanna KB. Use of selective decontamination of the digestive tract in United Kingdom intensive care units[J]. Anaesthesia, 2009, 64(1):46-49.
12.	Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque[J]. J Bacteriol, 2001, 183(12):3770-3783.
13.	Garrouste-Orgeas M, Chevret S, Arlet G, et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis[J]. Am J Respir Crit Care Med, 1997, 156(5):1647-1655.
14.	Garcia R. A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia:underappreciated risk and a call for interventions[J]. Am J Infect Control, 2005, 33(9):527-541.
15.	DeRiso AJⅡ, Ladowski JS, Dillon TA, et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery[J]. Chest, 1996, 109(6):1556-1561.
16.	Fourrier F, Cau-Pottier E, Boutigny H, et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients[J]. Intensive Care Med, 2000, 26(9):1239-1247.
17.	Bergmans DC, Bonten MJ, Gaillard CA, et al. Prevention of ventilator-associated pneumonia by oral decontamination:a prospective, randomized, double-blind, placebo-controlled study[J]. Am J Respir Crit Care Med, 2001, 164(3):382-388.
18.	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[J]. Crit Care Med, 2005, 33(8):1728-1735.
19.	Seguin P, Tanguy M, Laviolle B, et al. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma[J]. Crit Care Med, 2006, 34(5):1514-1519.
20.	Koeman M, Van Der Ven AJ, Hak E, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia[J]. Am J Respir Crit Care Med, 2006, 173(12):1348-1355.
21.	Segers P, Speekenbrink RG, Ubbink DT, et al. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate:a randomized controlled trial[J]. JAMA, 2006, 296(20):2460-2466.
22.	Tantipong H, Morkchareonpong C, Jaiyindee S, et al. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia[J]. Infect Control Hosp Epidemiol, 2008, 29(2):131-136.
23.	Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Viana JM, et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients[J]. Infect Control Hosp Epidemiol, 2009, 30(10):952-958.
24.	Scannapieco FA, Yu J, Raghavendran K, et al. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients[J]. Crit Care, 2009, 13(4):R117.

1. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States[J]. Crit Care Med, 1999, 27(5):887-892.
2. Chastre J, Jy F. Ventilator-associated pneumonia[J]. Am J Respir Crit Care Med, 2002, 165(7):867-903.
3. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review[J]. Crit Care Med, 2005, 33(10):2184-2193.
4. van der Waaij D, Berghuis-de Vries JM, Lekkerkerk-van der Wees JEC. Colonization resistance of the digestive tract in conventional and antibiotic-treated mice[J]. J Hyg (Lond), 1971, 69(3):405-411.
5. Stoutenbeek CP, van Saene HK, Miranda DR, et al. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients[J]. Intensive Care Med, 1984, 10(4):185-192.
6. De La Cal MA, Cerdá E, García-Hierro P, et al. Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract:a randomized, placebo-controlled, double-blind trial[J]. Ann Surg, 2005, 241(3):424-430.
7. Liberati A, D'amico R, Torri V, et al. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care[J]. Cochrane Database Syst Rev, 2004(1):CD000022.
8. Vandenbroucke-Grauls CM, Vandenbroucke JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit[J]. Lancet, 1991, 338(8771):859-862.
9. Kollef MH. Opinion:the clinical use of selective digestive decontamination[J]. Crit Care, 2000, 4(6):327-332.
10. Gastinne H, Wolff M, Delatour F, et al. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract[J]. N Engl J Med, 1992, 326(9):594-599.
11. Bastin AJ, Ryanna KB. Use of selective decontamination of the digestive tract in United Kingdom intensive care units[J]. Anaesthesia, 2009, 64(1):46-49.
12. Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque[J]. J Bacteriol, 2001, 183(12):3770-3783.
13. Garrouste-Orgeas M, Chevret S, Arlet G, et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis[J]. Am J Respir Crit Care Med, 1997, 156(5):1647-1655.
14. Garcia R. A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia:underappreciated risk and a call for interventions[J]. Am J Infect Control, 2005, 33(9):527-541.
15. DeRiso AJⅡ, Ladowski JS, Dillon TA, et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery[J]. Chest, 1996, 109(6):1556-1561.
16. Fourrier F, Cau-Pottier E, Boutigny H, et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients[J]. Intensive Care Med, 2000, 26(9):1239-1247.
17. Bergmans DC, Bonten MJ, Gaillard CA, et al. Prevention of ventilator-associated pneumonia by oral decontamination:a prospective, randomized, double-blind, placebo-controlled study[J]. Am J Respir Crit Care Med, 2001, 164(3):382-388.
18. 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[J]. Crit Care Med, 2005, 33(8):1728-1735.
19. Seguin P, Tanguy M, Laviolle B, et al. Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma[J]. Crit Care Med, 2006, 34(5):1514-1519.
20. Koeman M, Van Der Ven AJ, Hak E, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia[J]. Am J Respir Crit Care Med, 2006, 173(12):1348-1355.
21. Segers P, Speekenbrink RG, Ubbink DT, et al. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate:a randomized controlled trial[J]. JAMA, 2006, 296(20):2460-2466.
22. Tantipong H, Morkchareonpong C, Jaiyindee S, et al. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia[J]. Infect Control Hosp Epidemiol, 2008, 29(2):131-136.
23. Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Viana JM, et al. Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients[J]. Infect Control Hosp Epidemiol, 2009, 30(10):952-958.
24. Scannapieco FA, Yu J, Raghavendran K, et al. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients[J]. Crit Care, 2009, 13(4):R117.

West China Medical Journal

A Systematic Review of Selective Oropharyngeal Decontamination for the Prevention of Ventilator-associated Pneumonia

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