en
Scientific article
English

Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial

Published inJAMA, vol. 265, no. 20, p. 2704-2710
Publication date1991
Abstract

Secondary pneumonia in patients requiring mechanical ventilation has a high morbidity and mortality. Diagnosis is difficult and treatment failure common; therefore, preventive measures are important. In a double-blind, placebo-controlled trial, we evaluated selective decontamination of the oropharynx with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride (PNV) in 52 patients requiring mechanical ventilation during a 3- to 34-day period (mean, 10 days). Either PNV or placebo was administered six times daily in the oropharynx. During the first 12 days of intubation, tracheobronchial colonization by gram-negative bacteria and Staphylococcus aureus, as well as pneumonia, occurred less frequently in the PNV than in the placebo group (16% vs 78%; P less than.0001). Hospital mortality was not different, but systemic antibiotics were prescribed less often in the PNV group and no resistant microorganism emerged. In these critically ill patients, topical oropharyngeal antibiotic application lowered the rate of ventilator-associated pneumonia by a factor of 5, probably by interrupting the stomach-to-trachea route of infection, and decreased the requirement for intravenous antibiotics.

Keywords
  • Adult
  • Aged
  • Anti-Bacterial Agents
  • Bacteria/drug effects/growth & development
  • Bacterial Infections/prevention & control
  • Cross Infection/etiology/ prevention & control
  • Double-Blind Method
  • Drug Therapy, Combination/administration & dosage/ therapeutic use
  • Female
  • Humans
  • Incidence
  • Intensive Care Units
  • Male
  • Middle Aged
  • Oropharynx/microbiology
  • Pneumonia/etiology/ prevention & control
  • Respiration, Artificial/ adverse effects
Citation (ISO format)
PUGIN, Jérôme et al. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. In: JAMA, 1991, vol. 265, n° 20, p. 2704–2710. doi: 10.1001/jama.1991.03460200084041
Identifiers
ISSN of the journal0098-7484
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