Miyahira K-M, Martins M-L, Liberato W-F, Magno M-B, Ferreira D-D, Tenório J-R, Maia L-C, Castro G-F
Profº Rodolpho Paulo Rocco 325 Cidade Universitária da Universidade Federal do Rio de Janeiro Zipcode: 21941-913. Rio de Janeiro, RJ, Brazil
Med Oral Patol Oral Cir Bucal. 2025 Mar 1;30(2):e179-e191. doi: 10.4317/medoral.26706.
This study aimed to evaluate the impact of oral hygiene (OH) with chlorhexidine (CHX) on the evolution of nosocomial infections (NI).
Electronic searches were carried out in PubMed, Scopus, Cochrane Library, Web of Science, VHL, and Grey Literature databases. Randomized clinical trials were included. Methodological quality and risk of bias were assessed using RoB 2.0. Meta-analyses were carried out comparing patients who did or did not receive OH with CHX (0.05%, 0.12% and 2%) for NI, Ventilator-Associated Pneumonia (VAP), S. aureus infection (SA), duration of mechanical ventilation (MV), length of hospital stay and Intensive Care Unit (ICU). The certainty of evidence (CE) was evaluated with GRADE approach.
Thirteen studies were selected for quantitative and qualitative synthesis. The risk for VAP (RR 0.72 [0.58, 0.90], p=0.003) and NI (RR 0.70 [0.58, 0.83], p<0.001) were lower in patients of the CHX groups compared to controls, independently for [CHX] used for NI (RR≥0.49, p≤0.03). Patients who received CHX 2×/day presented similar risk to control (RR 0.98 [0.75, 1.30], p=0.91); while 3 and 4×/day or more (RR≥0.52, p≤0.002) presented lower risk for NI. Similar risk for SA was observed among groups (RR 0.42 [0.14, 1.26], p=0.12). The average days of hospitalization (p=0.67), ICU stay (p=0.37) and MV (p=0.57) did not differ between the groups. CE ranged from very low to moderate.
OH with CHX reduced NI, regardless of concentration, when used 3×/day or more. However, it had no effect against AS and did not reduce length of hospital stay.
本研究旨在评估使用氯己定（CHX）进行口腔卫生护理（OH）对医院感染（NI）发展的影响。
在PubMed、Scopus、Cochrane图书馆、科学网、虚拟健康图书馆（VHL）和灰色文献数据库中进行电子检索。纳入随机临床试验。使用RoB 2.0评估方法学质量和偏倚风险。进行荟萃分析，比较接受或未接受使用CHX（0.05%、0.12%和2%）进行OH护理的患者在NI、呼吸机相关性肺炎（VAP）、金黄色葡萄球菌感染（SA）、机械通气（MV）时长、住院时间和重症监护病房（ICU）方面的情况。采用GRADE方法评估证据的确定性（CE）。
选择了13项研究进行定量和定性综合分析。与对照组相比，CHX组患者发生VAP（风险比[RR] 0.72 [0.58, 0.90]，p = 0.003）和NI（RR 0.70 [0.58, 0.83]，p < 0.001）的风险较低，与用于NI的[CHX]浓度无关（RR≥0.49，p≤0.03）。每天接受2次CHX护理的患者与对照组风险相似（RR 0.98 [0.75, 1.30]，p = 0.91）；而每天3次及4次或更多次（RR≥0.52，p≤0.002）时，NI风险较低。各组间SA风险相似（RR 0.42 [0.14, 1.26]，p = 0.12）。各组间平均住院天数（p = 0.67）、ICU停留时间（p = 0.37）和MV时长（p = 0.57）无差异。CE范围从极低到中等。
每天使用3次或更多次CHX进行OH护理可降低NI风险，与浓度无关。然而，它对SA无效且未缩短住院时间。
