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December
7, 2006
By
Sahar
Bedrood B.S. and Asher Kimchi M.D.
Amsterdam
- Nosocomial infections after open-heart surgery is recognized
as an important cause of complications and mortality. Patrique
Segers, MD et al from the University of Amsterdam set out to
determine the efficacy of perioperative decontamination of the
nasopharynx and oropharynx with chlorhexidine gluconate for
reduction of nosocomial infection after cardiac surgery. Their
study, published in the November 22/29 issue of the Journal of
the American Medical Association found that decontamination with
chlorhexidine gluconate appears to be an effective method to
reduce nosocomial infection after cardiac surgery.
A prospective,
randomized, double-blind, placebo-controlled clinical trial was
conducted on 991 patients. The patients were administered either
a 0.12% chlorhexidine gluconate solution or a placebo. The
oropharyngeal solution was used as a mouth rinse and applied to
the buccal, pharyngeal, gingival, and tooth surfaces for 30
seconds 4 times daily. The nose ointment was applied 4 times a
day in both nostrils. The protocol was continued until the
nasogastric tube was removed, usually the day after surgery.
Staphylococcus
aureus
cultures of the nares were taken before randomization and at
time of surgery. Additionally, incidence of nosocomial infection
as well as rate of S aureus nasal carriage was monitored.
The incidence
of nosocomial infection in the chlorhexidine
gluconate group and placebo group was 19.8% and 26.2%,
respectively (absolute risk reduction [ARR], 6.4%;
95% confidence interval [CI], 1.1%-11.7%; P = .002).
In particular, lower respiratory tract infections and
deep surgical site infections were less common in the
chlorhexidine gluconate group than in the placebo
group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002;
and 3.2%; 95% CI, 0.9%-5.5%; P = .002,
respectively). For the prevention of 1 nosocomial
infection, 16 patients needed to be treated with
chlorhexidine gluconate. A significant reduction of
57.5% in S aureus nasal carriage was found in the
chlorhexidine gluconate group compared with a
reduction of 18.1% in the placebo group (P<.001).
Total hospital stay for patients treated with
chlorhexidine gluconate was 9.5 days compared with 10.3
days in the placebo group (ARR, 0.8 days; 95% CI,
0.24-1.88; P = .04).
The study
concluded that decontamination of the nasopharynx and oropharynx
with chlorhexidine gluconate appears to be an effective method
to reduce nosocomial infection after cardiac surgery.
Co-authors:
Patrique Segers, MD; Ron G. H. Speekenbrink, PhD; Dirk T. Ubbink,
PhD, Marc L. can Ogtrop, PhD, Bas A. de Mol, MD, PhD
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