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979 Topical Chlorhexidine for Prevention of Ventilator-Associated Pneumonia: A Meta-Analysis

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Nasia Safdar, MD , University of Wisconsin Madison, Madison, WI
Aiman Ghufran, MD , University of Wisconsin Madison, Madison, WI
Germana LM Silva , University of Wisconsin Madison, Madison, WI
Piotr Chlebicki, MD , Singapore Medical hospital, Singapore, Singapore
J. Drew Zimmer , Northeast regional medical center, Kirksville, MO
Mary AM Rogers , University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI
Sanjay Saint, MD, MPH , University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI

Background: Preventing ventilator-associated pneumonia (VAP) is essential to reduce the morbidity and mortality associated with this serious healthcare-associated infection. Topical oral chlorhexidine has been proposed a method to reduce VAP.

Objective: To undertake a meta-analysis of randomized controlled trials to assess the efficacy of topical oral chlorhexidine for preventing VAP.

Methods: Data sources include PUBMED, CURRENT CONTENTS, CINAHL, DARE, COCHRANE (inception through July 13, 2009), as well as GOOGLE, conference abstracts, the NIH trial registry, reference lists, and contact with authorities in the field. Randomized controlled trials evaluating efficacy of topical chlorhexidine applied to the oropharynx versus placebo (or standard care) for preventing VAP were selected. Data were extracted on the diagnostic criteria for VAP, form and concentration of topical chlorhexidine, patient characteristics, incidence of VAP and overall mortality. Pooled estimates of the relative risk (RR) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2.

Results: Eleven randomized controlled trials met the inclusion criteria. The incidence of VAP ranged from 0% to 40.9% in patients given chlorhexidine versus 5.0% to 54.9% in control patients across the 11 trials.  Chlorhexidine resulted in a reduced incidence of VAP using a fixed effects model (RR 0.67, 95% CI 0.56-0.81, P< 0.001) and a random effects model (RR 0.69, 95% CI 0.54-0.87, P= 0.002). The benefit of chlorhexidine was most marked in cardiac surgery patients (RR 0.55, 95% CI 0.40-0.77, P= 0.0003). Overall, mortality trended higher in the group given chlorhexidine (RR 1.15, 95% CI 0.98 to 1.34, P= 0.067).

Conclusions: Topical application of chlorhexidine is useful for preventing VAP in mechanically ventilated patients, with the benefit being most marked in cardiac surgery patients.  Why mortality did not correlate with VAP incidence is not known.