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Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis

Sonia Labeau UGent, Katrien Van de Vyver UGent, Nele Brusselaers UGent, Dirk Vogelaers UGent and Stijn Blot UGent (2011) LANCET INFECTIOUS DISEASES. 11(11). p.845-854
abstract
Background We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults. Methods Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the 12 test. Findings 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98). Interpretation This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
POVIDONE-IODINE, 0.2-PERCENT CHLORHEXIDINE, NOSOCOMIAL INFECTIONS, CHLORHEXIDINE GLUCONATE, INTENSIVE-CARE UNITS, RANDOMIZED CONTROLLED-TRIAL, RESPIRATORY-TRACT INFECTIONS, HEART-SURGERY, DECONTAMINATION, RINSE
journal title
LANCET INFECTIOUS DISEASES
Lancet Infect. Dis.
volume
11
issue
11
pages
845 - 854
Web of Science type
Review
Web of Science id
000296399700020
JCR category
INFECTIOUS DISEASES
JCR impact factor
17.391 (2011)
JCR rank
1/70 (2011)
JCR quartile
1 (2011)
ISSN
1473-3099
DOI
10.1016/S1473-3099(11)70127.X
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1974210
handle
http://hdl.handle.net/1854/LU-1974210
date created
2011-12-23 16:17:19
date last changed
2016-12-19 15:42:22
@article{1974210,
  abstract     = {Background We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults. 
Methods Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95\% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the 12 test. 
Findings 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95\% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95\% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95\% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29\%; p=0.16) for the trials using chlorhexidine and high (I(2)=67\%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2\% chlorhexidine (RR 0.53, 95\% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95\% CI 0.17-0.98). 
Interpretation This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients.},
  author       = {Labeau, Sonia and Van de Vyver, Katrien and Brusselaers, Nele and Vogelaers, Dirk and Blot, Stijn},
  issn         = {1473-3099},
  journal      = {LANCET INFECTIOUS DISEASES},
  keyword      = {POVIDONE-IODINE,0.2-PERCENT CHLORHEXIDINE,NOSOCOMIAL INFECTIONS,CHLORHEXIDINE GLUCONATE,INTENSIVE-CARE UNITS,RANDOMIZED CONTROLLED-TRIAL,RESPIRATORY-TRACT INFECTIONS,HEART-SURGERY,DECONTAMINATION,RINSE},
  language     = {eng},
  number       = {11},
  pages        = {845--854},
  title        = {Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1016/S1473-3099(11)70127.X},
  volume       = {11},
  year         = {2011},
}

Chicago
Labeau, Sonia, Katrien Van de Vyver, NELE BRUSSELAERS, Dirk Vogelaers, and Stijn Blot. 2011. “Prevention of Ventilator-associated Pneumonia with Oral Antiseptics: a Systematic Review and Meta-analysis.” Lancet Infectious Diseases 11 (11): 845–854.
APA
Labeau, S., Van de Vyver, K., BRUSSELAERS, N., Vogelaers, D., & Blot, S. (2011). Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. LANCET INFECTIOUS DISEASES, 11(11), 845–854.
Vancouver
1.
Labeau S, Van de Vyver K, BRUSSELAERS N, Vogelaers D, Blot S. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. LANCET INFECTIOUS DISEASES. 2011;11(11):845–54.
MLA
Labeau, Sonia, Katrien Van de Vyver, NELE BRUSSELAERS, et al. “Prevention of Ventilator-associated Pneumonia with Oral Antiseptics: a Systematic Review and Meta-analysis.” LANCET INFECTIOUS DISEASES 11.11 (2011): 845–854. Print.