Oropharyngeal decontamination

Decontamination of the oropharynx plays an important role in the prevention of hospital infections. In a large trial, selective decontamination of the oropharynx and the digestive tract, combined with intravenous antibiotics, reduced the rate of infections only slightly more than just decontamination of the oropharynx [5]. For the oropharyngeal... 

Oropharyngeal decontamination was not included in the first protocol of SDD in mechanically ventilated patients. However, gastrointestinal decontamination alone did not influence the incidence of respiratory tract infections among multiple trauma patients when compared to a historical control group (27). Addition to the SDD regimen of an oropharyngeal paste containing topi-... 

The use of the combination of intestinal and oropharyngeal decontamination still did not significantly reduce the overall incidence of respiratory tract infections (27), because a large proportion of respiratory tract infections occurred within the first 4 days of mechanical ventilation, before decontamination was established. These cases of early-onset pneumonia were caused by pathogens that had already contaminated patients lower respiratory tract in the period shortly before, or after, ICU admission, and therefore could not be eradicated by intestinal and oropharyngeal decontamination. Addition of 3 to 7 days (28) of systemic prophylaxis to the SDD regimen resulted in a further reduction of the early-onset infections (27), presumably as a result of preemptive therapy of incubating pneumonia. 

Table 4 Characteristics of Studies Using Oropharyngeal Decontamination in Critically 111 Patients... 

Two studies determined the effects of oropharyngeal decontamination alone, and one determined the effect of oropharyngeal decontamination and systemic prophylaxis on the incidence of VAP (see Table 4) (74-76). Only one of these studies used a placebo-controlled, double-blind study design (74). Although significant reductions in the incidence of VAP were reported in all three stud-... 

Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Langrehr D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1987 27 357-364. 

Pugin J, Auckenthaler R, Lew DP, Suter PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia a randomized, placebo-controlled, double-blind clinical trial. J Am Med Assoc 1991 265 2704-2710. 

Abele-Horn M, Dauber A, Bauernfeind A, et al. Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination. Intens Care Med 1996 23 187-195. 

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