Topical Antiseptic Cuts Chances of Pneumonia
Study shows a decrease of 65% in patients on ventilators
THURSDAY, June 15, 2006 (HealthDay News) -- Application of an antiseptic paste inside the cheeks of critically ill patients on ventilators reduces the chances of contracting pneumonia, a new Dutch study finds.
Pneumonia linked to ventilator usage in patients is the second most-common acquired illness in a hospital, and can often be deadly. Twenty-seven percent of critically ill patients on ventilators will contract the disease, and it is fatal in roughly 20 percent to 60 percent of those patients.
A study conducted at the University Medical Center Utrecht, in the Netherlands, tested an oral chlorhexidine paste to see its effect on preventing pneumonia in 385 patients on ventilators. All of the patients tested in the study had been ventilated for at least 48 hours. The paste was applied every six hours inside the cheeks of 127 intubated, ventilated, critically ill patients, and 128 patients on ventilators received a paste of both chlorhexidine and colistin, an antibiotic. Another 130 ventilated patients received a placebo paste inside the cheek.
Chlorhexidine paste alone reduced the incidence of pneumonia in patients by 65 percent, compared to a 55 percent reduction with the antiseptic-plus-antibiotic paste. Only 13 patients (10 percent) contracted ventilator-associated pneumonia in the antiseptic-only group, while 16 patients (13 percent) in the antiseptic/antibiotic combination group and 23 (18 percent) in the control group were diagnosed with pneumonia. Researchers tested the levels of microorganisms present in the mouths of these patients by taking oropharyngeal swabs.
The findings, reported in the June issue of the American Journal of Respiratory and Critical Care Medicine, note the antiseptic pastes did not appear to have an effect on the duration of a patient's ventilation or hospital stay -- or on overall survival rates of these patients in the ICU. They were, however, a very cost-effective way to control an illness than can cost anywhere from $12,000 to $40,000 per patient to treat.
"The interventions tested cost less than $100 per patient, making them extremely cost-effective," Dr. Mirelle Koeman, of the university's Department of Emergency Medicine and Infectious Diseases, said in a prepared statement.
Dr. Donald E. Craven, of Lahey Clinic Medical Center in Burlington, Mass., and Dr. Robert A. Duncan, of Tufts University School of Medicine in Boston, wrote an accompanying editorial voicing their concerns about the study.
"The use of 'sequential analysis' is an intriguing concept and offers the promise of more efficient study design, but the small number may have limited power and increased the possibility of an erroneous conclusion. For example, there appear to be significantly more males and patients with infections in the placebo group, which questions the effectiveness of randomization. Second, it is difficult to reconcile significant reductions in ventilator-associated pneumonia with an absence of effect on ventilator days, length stay and mortality," they wrote.
Craven and Duncan also noted that further study is needed to understand how chlorhexidine works to prevent ventilator-associated pneumonia, and how it can be used in conjunction with other treatments.
The U.S. Centers for Disease Control and Prevention has more details on ventilator-associated pneumonia.