Chlorhexidine 可以降低細菌性肺炎發生率－矯正醫生的狂想曲--- Straight teeth and life

****口內菌和院內感染(肺炎)有關

研究指出口腔內擦拭Chlorhexidine swab對於使用呼吸器的重症ICU病患，可以降低細菌性肺炎發生率。刷牙沒有殺菌作用所以效果不彰。其他研究指出心臟手術前後、住院中持續使用Chlorhexidine，可以預防院內感染。

哇！沒想到Chlorhexidine 在治療牙周病之外，也有重大貢獻！眨眼睛

----Chlorhexidine, Tooth Brushing, and Preventing Ventilator-associated Pneumonia in Critically Ill Adults

Cindy L. Munro, et al. American Journal of Critical Care. 2010;18(5):428-37.

Ventilator-associated pneumonia (VAP) is associated with increased health care costs, morbidity, and mortality. Chlorhexidine oral swabbing was effective in reducing early VAP in patients in medical, surgical/trauma, and neuroscience ICUs who did not have pneumonia at baseline. Toothbrushing did not reduce the incidence of VAP, and combining toothbrushing and chlorhexidine did not provide additional benefit over use of chlorhexidine alone.

* Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS). In this study, topical application of chlorhexidine 0.12% solution to the oral cavity significantly reduced the incidence of pneumonia on day 3 among patients who did not have pneumonia at baseline (P = .006).

Conclusions: 0.12%Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.

<附記Note>

The toothbrushing protocol did not have a significant effect on VAP. Toothbrushing mechanically reduces the number of organisms without residual activity on the organisms remaining in the mouth; however the intermittent reduction was insufficient to reduce the risk for pneumonia.

Chlorhexidine is a broadspectrum antibacterial agent that has been used extensively in healthy populations as an oral rinse to control dental plaque and to prevent and treat gingivitis. Clorhexidine has bactericidal activity ; microbial resistance to chlorhexidine has not been demonstrated, and the drug has minimal side effects.

The most recent (2004) Centers for Disease Control and Prevention recommendations for prevention of nosocomial bacterial pneumonia in patients receiving mechanical ventilation specifically address the importance of oral microbial flora in the development of VAP. Recommendations for patients having elective cardiac surgery include the use of chlorhexidine during the perioperative period and are based on the results of studies in which patients began using chlorhexidine before hospital admission for elective cardiac surgery and chlorhexidine use was continued throughout the hospital stay.

Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36.
DeRiso AJ, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109:1556–1561.
Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care. 2002;11:567–570.
Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA. 2006;296:2460–2466.