Ventilation Decontamination Strategies Produce Similar Results to Standard of Care

Chlorhexidine mouthwash, selective oropharyngeal decontamination, and selective digestive tract decontamination do not decrease the risk of bloodstream infections when compared with standard of care among ventilated patients in the intensive care unit (ICU), according to new data.

To reach this finding, the researchers conducted a randomized trial from December 1, 2013, to May 31, 2017, in 13 European ICUs, in each of which extended-spectrum β-lactamase–producing Enterobacteriaceae caused at least 5% of its bloodstream infections.

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Final follow-up ended on September 20, 2017.

In all, data on 8665 participants were analyzed. Participants were eligible if they had anticipated mechanical ventilation of more than 24 hours.

First, for a baseline period from 6 to 14 months, the ICUs followed standard care of daily chlorhexidine body washing and a hand hygiene improvement program.

Then each ICU was randomly assigned to one of the following 6-month interventions: chlorhexidine 2% mouthwash, selective oropharyngeal decontamination (mouthpaste with colistin, tobramycin, and nystatin), or selective digestive tract decontamination (the same mouthpaste and gastrointestinal suspension with the same antibiotics). Each ICU used the respective decontaminant 4 times per day.

ICU-acquired bloodstream infection with multidrug-resistant gram-negative bacteria, as well as 28-day mortality, in each intervention group were similar to those during the baseline period.

During the baseline period, 2.1% of participants using chlorhexidine mouthwash, 1.8% using selective oropharyngeal decontamination, and 1.2% using selective digestive tract decontamination periods developed an ICU-acquired bloodstream infection with multidrug-resistant gram-negative bacteria.

The crude mortality risks on day 28 for the groups were 31.9%, 32.9%, 32.4%, and 34.1%, respectively.

—Colleen Murphy

Reference:

Wittekamp BH, Plantinga NL, Cooper BS, et al. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial. JAMA. 2018;320(20):2087-2098. doi:10.1001/jama.2018.13765.