Emergence of gram-negative bacilli in the mouths of bone marrow transplant recipients using chlorhexidine mouthrinse.

PURPOSE/OBJECTIVES: To examine whether use of chlorhexidine (CHX) in stomatitis-prevention regimens following bone marrow transplantation (BMT) enhances the emergence of gram-negative bacilli (GNB) to a degree that exceeds its benefits.

DATA SOURCES

Articles, book chapters, and case studies.

DATA SYNTHESIS

Despite rigorous topical and systemic antimicrobial therapy, oral opportunistic GNB infections occur following BMT. This is most likely because of low susceptibility of GNB to CHX and not that CHX predisposes patients to these infections or the development of CHX resistant strains.

CONCLUSIONS

The benefits of CHX use (e.g. preservation of oral mucosa and broad-spectrum antibacterial and antifungal effects) outweight the risks of GNB infection.

IMPLICATIONS FOR NURSING PRACTICE

Routine clinical and microbiologic monitoring of the oral cavity are essential with use of CHX. Stomatitis care standards and patient instructions following discharge are included.