Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine.
Abstract
Objectives Chlorhexidine (CHX) is the most commonly used oral hygiene product for the prevention of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation (MV). The change in dental plaque (DP) microbiota following CHX use in patients under MV has not been described previously. The aim of this study was to evaluate the incidence of pathogenic bacteria associated with VAP and the coverage of DP within the oral cavity in patients administered CHX.Methods This was a prospective, randomised, controlled, double-blind study in patients (n=16) under MV who were mouth-rinsed with either CHX or placebo. Microbiology samples were collected from the oral mucosa (OM) and DP after admission to the ICU and on Days 3, 5, 7 and 10. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CHX were determined.Results Upon admission, the occurrence of multidrug-resistant (MDR) bacteria, including carbapenem-resistant Klebsiella pneumoniae, was reported. The CHX group had a lower incidence of methicillin-resistant Staphylococcus aureus (MRSA) compared with the placebo group for the OM (RR=0.51, 95% CI 0.27-0.98; P=0.011). There was high agreement between the culture results of OM and DP (κ=0.825). VAP developed in six patients. The species identified following tracheal aspiration of VAP patients were similar to those found in the OM for four cases. The strains showed low MICs and MBCs for CHX (<0.039mg/mL).Conclusions Although DP is rapidly colonised by MDR bacteria, use of 2% CHX reduced the incidence of S. aureus colonisation.
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Improving oral hygiene care can reduce the risk and mortality risk of aspiration pneumonia by as much as 60%.
“Several studies have reported that improving oral hygiene care by either mechanical or chemical control of dental plaque biofilm formation can reduce the number of potential respiratory pathogens and consequently the risk and mortality risk of aspiration pneumonia by as much as 60% (Dennesen et al., 2003; Tuon et al., 2017).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Tuon et al., 2017
Improving oral hygiene care by either mechanical or chemical control of dental plaque biofilm formation can reduce the number of potential respiratory pathogens.
“Several studies have reported that improving oral hygiene care by either mechanical or chemical control of dental plaque biofilm formation can reduce the number of potential respiratory pathogens and consequently the risk and mortality risk of aspiration pneumonia by as much as 60% (Dennesen et al., 2003; Tuon et al., 2017).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Tuon et al., 2017
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Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection
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- Authors
- Tuon, F. F., Gavrilko, O., Almeida, S. D., Sumi, E. R., Alberto, T., Rocha, J. L., & Rosa, E. A.
- Affiliations
- Pontifícia Universidade Católica do Paraná (BR)
- Hospital Universitário Evangélico de Curitiba (BR)
- Corresponding author
- Tuon, Felipe Francisco
- Venue
- Journal of Global Antimicrobial Resistance
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 8
- Pages
- 159-163
- ISSN
- 2213-7165 (ISSN-L)
- OpenAlex
- W2590898695
- Cited by
- 66
- References
- 20
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 6 · 2023: 7 · 2022: 16 · 2021: 7 · 2020: 9 · 2019: 4 · 2018: 4 · 2017: 1 · 2013: 1
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Global Antimicrobial Resistance (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Keywords
- chlorhexidine, oral hygiene, ventilator-associated pneumonia, mechanical ventilation, dental plaque microbiota, oral microbiota, intensive care unit admission, multidrug-resistant bacteria, carbapenem-resistant Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, MRSA colonization, antimicrobial susceptibility, minimum inhibitory concentration, minimum bactericidal concentration, tracheal aspiration
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Infective Agents, Local, Bacteria, Chlorhexidine, Dental Plaque, Double-Blind Method, Female, Humans, Intensive Care Units, Male, Microbial Sensitivity Tests, Middle Aged, Mouth Mucosa, Oral Hygiene, Placebos, Prospective Studies, Treatment Outcome, Microbial Viability, Young Adult, Microbiota
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