Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study
Introduction: Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection. Aspiration of bacteria from the upper digestive tract is important in the pathogenesis of this infection. Oral decontamination using antiseptic like chlorhexidine reduces the incidence of VAP but...
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JCDR Research and Publications Private Limited
2022-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/17095/58684_CE(AD)_F[SK]_PF1(AG_SS)_PFA(SS)_PB(AG_SS)_PN(SS).pdf |
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| author | Matendra Singh Yadav Vipin Kumar Singh DK Singh |
| author_facet | Matendra Singh Yadav Vipin Kumar Singh DK Singh |
| author_sort | Matendra Singh Yadav |
| collection | DOAJ |
| description | Introduction: Ventilator Associated Pneumonia (VAP) is the
second most common nosocomial infection. Aspiration of
bacteria from the upper digestive tract is important in the
pathogenesis of this infection. Oral decontamination using
antiseptic like chlorhexidine reduces the incidence of VAP but not
mortality. There is conflicting results about oral decontamination
with antibiotics in preventing VAP, some suggesting benefit and
others showing no benefit.
Aim: To use two different prophylactic oral decontaminant,
gentamicin and chlorhexidine, to compare the incidence of VAP,
prevalence of bacterial flora, duration of Intensive Care Unit
(ICU) stay, and mortality.
Materials and Methods: This double-blind, randomised,
clinical study was conducted at Sir Sunder Lal Hospital,
Banaras Hindu University, Varanasi, Uttar Pradesh, India, from
January 2017 to December 2018. Patients intubated within 24
hours of admission and who needed mechanical ventilation
with an expected duration of more than 48 hours were included.
All the adult patients between age group 18-50 years were
studied. Patients were randomised to receive either Topical Antimicrobial Prophylaxis (TAP) with 2% gentamicin (Group
G) or 2% chlorhexidine (Group C). Patients were followed until
extubation or death. Sequential cultures from endotracheal tube
were sent on days 3,7,14, and 21, and for oropharyngeal swab
culture were sent on days 0, 3,7,14 and 21. VAP was diagnosed
with the help of Clinical Pulmonary Infection Score (CPIS).
Results: Out of 151 patients, 82 patients were in group G (2%
gentamicin) and 69 in group C (2% chlorhexidine). On follow-up of
various interval among both the groups, CPIS increased with ICU
stay but incidence of VAP was comparable between the groups
(50% vs 71%, p-value=0.009). Pseudomonas was found to be
most prevalent bacteria among both the groups. Discharge rate
from ICU was higher in group G (54.9%) than group C (52.2%)
(p-value=0.744). The mortality rate was higher in the group C
(43.9%) than group G (44.9%) (p-value=0.744).
Conclusion: Prophylactic oral-decontamination with gentamicin
or chlorhexidine does not reduce incidence of VAP and outcome
among ICU patients. Gentamicin could be a better option for
patients on ventilator because it may lead to less colonisation
of Pseudomonas in oral cavity along with lower CPIS in the later
stages of VAP. |
| first_indexed | 2024-04-10T21:40:16Z |
| format | Article |
| id | doaj.art-5e42d840d4564c41b05827faba011bd0 |
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| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-04-10T21:40:16Z |
| publishDate | 2022-10-01 |
| publisher | JCDR Research and Publications Private Limited |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-5e42d840d4564c41b05827faba011bd02023-01-19T04:22:29ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2022-10-011610UC40UC4310.7860/JCDR/2022/58684.17095Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical StudyMatendra Singh Yadav0Vipin Kumar Singh1DK Singh2Senior Resident, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.Additional Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.Director Professor, Department of Anaesthesiology, AIIMS, Bhatinda, Punjab, India.Introduction: Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection. Aspiration of bacteria from the upper digestive tract is important in the pathogenesis of this infection. Oral decontamination using antiseptic like chlorhexidine reduces the incidence of VAP but not mortality. There is conflicting results about oral decontamination with antibiotics in preventing VAP, some suggesting benefit and others showing no benefit. Aim: To use two different prophylactic oral decontaminant, gentamicin and chlorhexidine, to compare the incidence of VAP, prevalence of bacterial flora, duration of Intensive Care Unit (ICU) stay, and mortality. Materials and Methods: This double-blind, randomised, clinical study was conducted at Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from January 2017 to December 2018. Patients intubated within 24 hours of admission and who needed mechanical ventilation with an expected duration of more than 48 hours were included. All the adult patients between age group 18-50 years were studied. Patients were randomised to receive either Topical Antimicrobial Prophylaxis (TAP) with 2% gentamicin (Group G) or 2% chlorhexidine (Group C). Patients were followed until extubation or death. Sequential cultures from endotracheal tube were sent on days 3,7,14, and 21, and for oropharyngeal swab culture were sent on days 0, 3,7,14 and 21. VAP was diagnosed with the help of Clinical Pulmonary Infection Score (CPIS). Results: Out of 151 patients, 82 patients were in group G (2% gentamicin) and 69 in group C (2% chlorhexidine). On follow-up of various interval among both the groups, CPIS increased with ICU stay but incidence of VAP was comparable between the groups (50% vs 71%, p-value=0.009). Pseudomonas was found to be most prevalent bacteria among both the groups. Discharge rate from ICU was higher in group G (54.9%) than group C (52.2%) (p-value=0.744). The mortality rate was higher in the group C (43.9%) than group G (44.9%) (p-value=0.744). Conclusion: Prophylactic oral-decontamination with gentamicin or chlorhexidine does not reduce incidence of VAP and outcome among ICU patients. Gentamicin could be a better option for patients on ventilator because it may lead to less colonisation of Pseudomonas in oral cavity along with lower CPIS in the later stages of VAP.https://www.jcdr.net/articles/PDF/17095/58684_CE(AD)_F[SK]_PF1(AG_SS)_PFA(SS)_PB(AG_SS)_PN(SS).pdfclinical pulmonary infection scoreoral decontaminationoutcome |
| spellingShingle | Matendra Singh Yadav Vipin Kumar Singh DK Singh Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study Journal of Clinical and Diagnostic Research clinical pulmonary infection score oral decontamination outcome |
| title | Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study |
| title_full | Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study |
| title_fullStr | Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study |
| title_full_unstemmed | Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study |
| title_short | Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study |
| title_sort | efficacy of gentamicin versus chlorhexidine as a sole prophylactic oral decontaminant in reducing the incidence of ventilator associated pneumonia a randomised clinical study |
| topic | clinical pulmonary infection score oral decontamination outcome |
| url | https://www.jcdr.net/articles/PDF/17095/58684_CE(AD)_F[SK]_PF1(AG_SS)_PFA(SS)_PB(AG_SS)_PN(SS).pdf |
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