Department of Anaesthesiology and Intensive Care, Lund University and Skåne University Hospital, SE-221 85, Lund, Sweden.
Department of Anaesthesiology, County Hospital, Halmstad, Sweden.
Crit Care. 2018 Oct 28;22(1):272. doi: 10.1186/s13054-018-2209-4.
Pathogenic enteric bacteria aspirated from the oropharynx are the main cause of ventilator-associated pneumonia (VAP). Using chlorhexidine (CHX) orally or selective decontamination has been shown to reduce VAP. In a pilot study we found that oral care with the probiotic bacterium Lactobacillus plantarum 299 (Lp299) was as effective as CHX in reducing enteric bacteria in the oropharynx. To confirm those results, in this expanded study with an identical protocol we increased the number of patients and participating centres.
One hundred and fifty critically ill patients on mechanical ventilation were randomised to oral care with either standard 0.1% CHX solution (control group) or a procedure comprising final application of an emulsion of Lp299. Samples for microbiological analyses were taken from the oropharynx and trachea at inclusion and subsequently at defined intervals. Student's t test was used for comparisons of parameters recorded daily and Fisher's exact test was used to compare the results of microbiological cultures.
Potentially pathogenic enteric bacteria not present at inclusion were identified in oropharyngeal samples from 29 patients in the CHX group and in 31 samples in the probiotic group. Considering cultures of tracheal secretions, enteric bacteria were found in 17 and 19 samples, respectively. Risk ratios show a difference in favour of the Lp group for fungi in oropharyngeal cultures. VAP was diagnosed in seven patients in the Lp group and in 10 patients among the controls.
In this multicentre study, we could not demonstrate any difference between Lp299 and CHX used in oral care procedures regarding their impact on colonisation with emerging potentially pathogenic enteric bacteria in the oropharynx and trachea.
ClinicalTrials.gov, NCT01105819 . Registered on 9 April 2010. First part: Current Controlled Trials, ISRCTN00472141 . Registered on 22 November 2007 (published Critical Care 2008, 12:R136).
从口咽部吸入的病原性肠道细菌是呼吸机相关性肺炎（VAP）的主要原因。使用洗必泰（CHX）口腔或选择性去污染已被证明可降低 VAP。在一项初步研究中，我们发现使用益生菌植物乳杆菌 299（Lp299）进行口腔护理与 CHX 一样有效，可以减少口咽部的肠道细菌。为了证实这些结果，我们在这项采用相同方案的扩展研究中增加了患者数量和参与中心。
150 名接受机械通气的危重病患者被随机分配到口腔护理组，接受标准的 0.1%CHX 溶液（对照组）或包括 Lp299 乳液最终应用的程序。在纳入时和随后的特定时间从口咽和气管中采集样本进行微生物分析。学生 t 检验用于比较每天记录的参数，Fisher 确切检验用于比较微生物培养的结果。
在 CHX 组的 29 个样本和益生菌组的 31 个样本中，发现了纳入时不存在的潜在病原性肠道细菌。考虑到气管分泌物的培养，在 17 个和 19 个样本中分别发现了肠道细菌。风险比显示 Lp 组在口咽培养中真菌的差异有利于 Lp 组。在 Lp 组中诊断出 7 例 VAP，对照组中诊断出 10 例。
在这项多中心研究中，我们无法证明 Lp299 与用于口腔护理程序的 CHX 之间在对口咽部和气管中新兴潜在病原性肠道细菌定植的影响方面有任何差异。
ClinicalTrials.gov，NCT01105819。于 2010 年 4 月 9 日注册。第一部分：当前对照试验，ISRCTN00472141。于 2007 年 11 月 22 日注册（发表于《危重病医学》2008 年 12 期 136 页）。
