Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Department of Data Analysis and Mathematical Modeling, Ghent University, Coupure Links 653, 9000, Ghent, Belgium.
Intensive Care Med. 2018 Jul;44(7):1017-1026. doi: 10.1007/s00134-018-5171-3. Epub 2018 May 9.
Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population.
In this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012-2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme).
The study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32-2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51-6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96-2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90-1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2-49.1).
These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.
洗必泰口腔护理在危重症和非危重症住院患者中被广泛用于维持口腔健康。我们调查了普通住院人群中洗必泰口腔护理对死亡率的影响。
在这项单中心、回顾性、全院范围、观察性队列研究中，我们纳入了成年住院患者（2012-2014 年）。通过逻辑回归分析评估与洗必泰口腔护理相关的死亡率。300 毫克的累积剂量作为洗必泰暴露的二分代理。我们调整了人口统计学、诊断类别和以四个类别（轻度、中度、重度和极度）表示的死亡风险。
研究队列包括 82274 名患者，其中 11133 名（14%）接受了洗必泰口腔护理。低水平的洗必泰口腔护理暴露（≤300 毫克）与死亡风险增加相关[比值比（OR）2.61；95%置信区间（CI）2.32-2.92]。这种关联在死亡风险较低的患者中更为明显：轻度/中度风险的 OR 为 5.50（95%CI 4.51-6.71），重度风险的 OR 为 2.33（95%CI 1.96-2.78），死亡率极高的 OR 为 1.13（95%CI 0.90-1.41）。高剂量暴露（>300 毫克）也观察到类似的结果。在接受机械通气和未接受机械通气且未入住 ICU 的患者中未观察到有害影响。在未接受机械通气且未入住 ICU 的患者中观察到死亡风险增加。需要暴露的患者数量以增加一个死亡病例的比例为 47.1（95%CI 45.2-49.1）。
这些数据反对在没有明确证明特定人群受益的情况下，在住院患者中不加区分地广泛使用洗必泰口腔护理。
