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

Abstract

IntroductionGiven the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients.MethodsA meta-analysis of randomised controlled trials was performed. The U.S. National Library of Medicine's MEDLINE database, Embase, and Cochrane Library computerized bibliographic databases, and reference lists of selected studies were used. Selection criteria for inclusion were: randomised controlled trials (RCTs); primary studies; examining the reduction of VAP and/or mortality and/or all ICU-acquired infections in ICU patients by prophylactic use of one or more of following topical treatments: 1) oropharyngeal decontamination using antiseptics or antibiotics, 2) gastrointestinal tract decontamination using antibiotics, 3) oropharyngeal plus gastrointestinal tract decontamination using antibiotics and 4) respiratory tract decontamination using antibiotics; reported enough data to estimate the odds ratio (OR) or risk ratio (RR) and their variance; English language; published through June 2010.ResultsA total of 28 articles met all inclusion criteria and were included in the meta-analysis. The overall estimate of efficacy of topical SDRD in the prevention of VAP was 27% (95% CI of efficacy = 16% to 37%) for antiseptics and 36% (95% CI of efficacy = 18% to 50%) for antibiotics, whereas in none of the meta-analyses conducted on mortality was a significant effect found. The effect of topical SDRD in the prevention of all ICU-acquired infections was statistically significant (efficacy = 29%; 95% CI of efficacy = 14% to 41%) for antibiotics whereas the use of antiseptics did not show a significant beneficial effect.ConclusionsTopical SDRD using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research.

Effect of Oral Hygiene and 0.12% Chlorhexidine Gluconate Oral Rinse in Preventing Ventilator-Associated Pneumonia After Cardiovascular Surgery

“…These data are in agreement with the effects shown by others. [37][38][39] Although not critically ill and not usually requiring mechanical ventilation support for Ͼ 24 h, patients undergoing elective cardiac surgery are likely to develop VAP. For example, this study found a decreased incidence of VAP with oral hygiene and chlorhexidine gluconate oral rinses 72h before surgery and therefore before endotracheal intubation.…”

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

“…[9][10][11][12][13][14][15] The most important measures are continuous medical education, [16][17][18] continuous suctioning of subglottic secre-tions, 19 semi-recumbent position, 11,[20][21][22][23][24][25] oral hygiene with chlorhexidine, 26 and selective digestive decontamination. 6,[27][28][29][30][31] Knowledge of guidelines for prevention of VAP among healthcare workers (HCWs) has been infrequently assessed and mainly in staff nurses only. The gaps between individual knowledge of VAP prevention and actual daily clinical practice have not been compared.…”

The effect of subglottic secretion drainage on the incidence of ventilator associated pneumonia

“…This may be the reason why they are not commonly applied 2,3 , VAP infections in intensive care units are a phenomenon with a range of health issues. They are the reason behind prolonged hospitalisation, increased mortality and significant increase in treatment costs 4,5 . According to the literature, 20-50% of all hospital infections are developed in ICUs, with a significant portion of those consisting of VAP infections [6][7][8][9] .…”