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[PMID]:29211279
[Au] Autor:Balejo RDP; Cortelli JR; Costa FO; Cyrino RM; Aquino DR; Cogo-Müller K; Miranda TB; Moura SP; Cortelli SC
[Ad] Endereço:Universidade de Taubaté, Departamento de Odontologia, Taubaté, SP, Brasil.
[Ti] Título:Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial.
[So] Source:J Appl Oral Sci;25(6):586-595, 2017 Nov-Dec.
[Is] ISSN:1678-7765
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. MATERIAL AND METHODS: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). RESULTS: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. CONCLUSIONS: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.
[Mh] Termos MeSH primário: Bacteriemia/prevenção & controle
Clorexidina/administração & dosagem
Raspagem Dentária
Gengivite/tratamento farmacológico
Antissépticos Bucais/administração & dosagem
Periodontite/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Bacteriemia/tratamento farmacológico
Feminino
Seres Humanos
Masculino
Meia-Idade
Periodontite/microbiologia
Reação em Cadeia da Polimerase em Tempo Real
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Mouthwashes); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:28468901
[Au] Autor:Janssen LMA; Tostmann A; Hopman J; Liem KD
[Ad] Endereço:Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
[Ti] Título:0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report.
[So] Source:Arch Dis Child Fetal Neonatal Ed;103(2):F97-F100, 2018 Mar.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The skin disinfectant '0.5% chlorhexidine gluconate in 70% alcohol' (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26 weeks). In April 2013, 0.2% chlorhexidine gluconate solution in acetate (0.2% CHG-acetate) was introduced as skin disinfectant for extremely preterm infants in our neonatal intensive care units. We aimed to compare the incidence of skin lesions and central line-associated bloodstream infection (CLABSI) among extremely preterm infants when using 0.5% CHG-70% alc and 0.2% CHG-acetate. DESIGN: Retrospective pre-post comparison cohort study. PATIENTS: All electronic patient records of extremely preterm infants born between January 2011-March 2013 ('0.5% CHG-70% alc' cohort) and April 2013-October 2015 ('0.2% CHG-acetate' cohort) were reviewed. MAIN OUTCOME MEASURES: The incidence of skin lesions and CLABSI. Skin lesions were defined as the presence of erythema, blisters, excoriation, oedema or induration. CLABSI was defined according to the definition of the US Centers for Disease Control and Prevention. RESULTS: The incidence of skin lesions was 22% (95% CI 11% to 37%) in the '0.5% CHG-70% alc' cohort (n=41) and 5% (95% CI 1% to 15%; p=0.02) in the '0.2% CHG-acetate' cohort (n=41). The incidence of CLABSI was the same in both groups (28%; 95% CI 14% to 46% in '0.5% CHG-70% alc' vs 27%; 95% CI 14% to 44% in '0.2% CHG-acetate'; p=0.98). CONCLUSIONS: Using 0.2% CHG-acetate as skin disinfectant in extremely preterm infants resulted in statistically significant reduction of skin lesions, without increasing the risk of CLABSI as compared with 0.5% CHG-70% alc.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Infecções Relacionadas a Cateter/prevenção & controle
Clorexidina/análogos & derivados
Infecção Hospitalar/prevenção & controle
Lactente Extremamente Prematuro
Dermatopatias/prevenção & controle
[Mh] Termos MeSH secundário: Cateteres Venosos Centrais
Clorexidina/administração & dosagem
Registros Eletrônicos de Saúde
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Unidades de Terapia Intensiva Neonatal
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); MOR84MUD8E (chlorhexidine gluconate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2017-312694


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[PMID]:29315313
[Au] Autor:Obermeier A; Schneider J; Harrasser N; Tübel J; Mühlhofer H; Pförringer D; Deimling CV; Foehr P; Kiefel B; Krämer C; Stemberger A; Schieker M; Burgkart R; von Eisenhart-Rothe R
[Ad] Endereço:Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
[Ti] Título:Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI).
[So] Source:PLoS One;13(1):e0190912, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. OBJECTIVES: This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. METHODS: As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 µg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 µg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. RESULTS: Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 µg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log). CONCLUSIONS: Novel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first-clinically most relevant- 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Aderência Bacteriana
Clorexidina/administração & dosagem
Piridinas/administração & dosagem
Staphylococcus aureus/fisiologia
Infecção da Ferida Cirúrgica/prevenção & controle
Suturas
[Mh] Termos MeSH secundário: Microscopia Eletrônica de Varredura
Infecção da Ferida Cirúrgica/microbiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); 0 (Pyridines); OZE0372S5A (octenidine); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190912


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[PMID]:29381914
[Au] Autor:Wang Z; Zheng J; Zhao Y; Xiang Y; Chen X; Zhao F; Jin Y
[Ad] Endereço:Department of Orthopaedics, Henan Provincial People's Hospital.
[Ti] Título:Preoperative bathing with chlorhexidine reduces the incidence of surgical site infections after total knee arthroplasty: A meta-analysis.
[So] Source:Medicine (Baltimore);96(47):e8321, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infection is a devastating postoperative complication, and the occurrence ranges from 1% to 2% after total knee arthroplasty (TKA). The efficacy of the preoperative use of chlorhexidine for reducing infection has been debated. This meta-analysis aimed to examine the efficacy of the use of chlorhexidine to prevent surgical site infections after TKA. METHODS: In February 2017, a systematic literature review was conducted using the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) and retrospective comparative study (RCS) that compared the use of chlorhexidine versus control washes to prep patients for TKA were retrieved. The primary endpoint was to compare the total incidence of infection with and without the use of chlorhexidine. The secondary outcomes were the incidence of infection in low-risk category patients, moderate-risk category patients, and high-risk category patients. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects modeling when necessary. RESULTS: Four clinical trials that included 8787 patients (chlorhexidine group: n = 2615, control group: n = 6172) were ultimately included in the meta-analysis. Chlorhexidine was associated with a reduced total incidence of infection, corresponding to a reduction of 1.69% [risk ratio (RR) = 0.22; 95% confidence interval (95% CI) = 0.12-0.40; P = .000]. Similarly, chlorhexidine was associated with a reduction in the incidence of infection among patients in the moderate-risk category (RR, 0.18; 95% CI, 0.05-0.63; P = .007) and the high-risk category (RR, 0.13; 95% CI, 0.03-0.67; P = .014). There was no significant difference between the incidence of infection in low-risk category patients with chlorhexidine use compared with the use of control washes (RR, 0.60; 95% CI, 0.22-1.60; P = .330). CONCLUSION: The preoperative use of chlorhexidine could reduce the total incidence of infection and the incidence of infection in moderate-risk and high-risk category patients. The overall evidence and the number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of chlorhexidine on reducing the incidence of infection after TKA.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/administração & dosagem
Artroplastia do Joelho/métodos
Banhos/métodos
Clorexidina/administração & dosagem
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Seres Humanos
Cuidados Pré-Operatórios
Estudos Retrospectivos
Fatores de Risco
Autocuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008321


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[PMID]:28456351
[Au] Autor:Luo D; Shahid S; Sukhorukov GB; Cattell MJ
[Ad] Endereço:School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
[Ti] Título:Synthesis of novel chlorhexidine spheres with controlled release from a UDMA-HEMA resin using ultrasound.
[So] Source:Dent Mater;33(6):713-722, 2017 06.
[Is] ISSN:1879-0097
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Establish the release kinetics of new chlorhexidine particles incorporated in a dental resin, and with the application of ultrasound. METHODS: Spherical chlorhexidine particles (SCP) were synthesized (5wt%), freeze dried and incorporated into UDMA-HEMA resins. Chlorhexidine diacetate (CDP) (5wt%) was similarly incorporated in separate resins. Resin discs were immersed in deionized water, and a release profile established (650h). Ultrasound was used to trigger chlorhexidine (CHX) release from the resin discs at specific durations (10-30s) and time intervals (1-425h). Chlorhexidine content was determined by UV-vis absorption. The chlorhexidine particles/polymer composites were characterized using TGA, SEM, and confocal microscopy. RESULTS: SCP exhibited structures with high chlorhexidine content (90-95%), and a Mean (SD) diameter of 17.2 (2.5)µm which was significantly (p<0.001) smaller than the CDP crystals at 53.6 (33.7)µm. The SCP discs had a lower (7.7%) CHX release compared to the CDP group (16.2%). Ultrasonication of the resin discs with increasing durations (10-30s) resulted in higher drug release rates. CDP release rates (CHX) over 650h were: 23.5% (10s), 42.6% (20s), 51.2% (30s), and for SCP (CHX) were; 9.8% (10s), 12.3% (20s), and 14.0% (30s). SEM/confocal microscopy revealed CDP discs exhibited dissolution associated with the particle surface and SCP from the interior. SIGNIFICANCE: Chlorhexidine spheres incorporated in a dental resin demonstrated a responsive and lower CHX release. Ultrasound enhanced CHX release and is useful in clinical situations where the drug is required on demand to treat severe or persistent infections.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais
Clorexidina
Resinas Compostas
Preparações de Ação Retardada
[Mh] Termos MeSH secundário: Teste de Materiais
Metacrilatos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); 0 (Composite Resins); 0 (Delayed-Action Preparations); 0 (Methacrylates); 6E1I4IV47V (hydroxyethyl methacrylate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


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[PMID]:28448359
[Au] Autor:Aschenbrenner DS
[Ad] Endereço:Diane S. Aschenbrenner is an assistant professor at Notre Dame of Maryland University in Baltimore. She also coordinates Drug Watch: daschenbrenner@ndm.edu.
[Ti] Título:Rare Allergic Reaction to Topical Chlorhexidine Gluconate.
[So] Source:Am J Nurs;117(5):20, 2017 May.
[Is] ISSN:1538-7488
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anafilaxia/induzido quimicamente
Anti-Infecciosos Locais/efeitos adversos
Clorexidina/análogos & derivados
[Mh] Termos MeSH secundário: Anafilaxia/enfermagem
Clorexidina/efeitos adversos
Seres Humanos
Vigilância de Produtos Comercializados
[Pt] Tipo de publicação:NEWS
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); MOR84MUD8E (chlorhexidine gluconate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1097/01.NAJ.0000516268.32086.24


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[PMID]:28463667
[Au] Autor:Choudhury MA; Sidjabat HE; Rathnayake IU; Gavin N; Chan RJ; Marsh N; Banu S; Huygens F; Paterson DL; Rickard CM; McMillan DJ
[Ad] Endereço:2​Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Australia.
[Ti] Título:Culture-independent detection of chlorhexidine resistance genes qacA/B and smr in bacterial DNA recovered from body sites treated with chlorhexidine-containing dressings.
[So] Source:J Med Microbiol;66(4):447-453, 2017 Apr.
[Is] ISSN:1473-5644
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Dressings containing chlorhexidine gluconate (CHG) are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in staphylococci is primarily associated with the presence of qacA/B and smr genes. METHODOLOGY: We used a culture-independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG dressings. RESULTS: Of the 78 DNA specimens analysed, 52 (67 %) possessed qacA/B and 14 (18 %) possessed smr; all samples positive for smr were also positive for qacA/B. These prevalence rates were not statistically greater than those observed in a subsample of specimens taken from non-CHG treated contralateral arms and non-CHG-dressing exposed arms. A statistically greater proportion of specimens with greater than 72 h exposure to CHG dressings were qac-positive (P=0.04), suggesting that the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qac genes was not positively associated with the presence of DNA specific for Staphylococcusepidermidis and Staphylococcusaureus in these specimens. CONCLUSION: Our results show that CHG genes are highly prevalent on hospital patients' skin, even in the absence of viable bacteria.
[Mh] Termos MeSH primário: Antiporters/genética
Proteínas de Bactérias/genética
Clorexidina/análogos & derivados
Desinfetantes/farmacologia
Proteínas de Membrana Transportadoras/genética
Staphylococcus aureus/genética
Staphylococcus epidermidis/genética
[Mh] Termos MeSH secundário: Bandagens/microbiologia
Cateterismo Venoso Central
Clorexidina/farmacologia
DNA Bacteriano/genética
Farmacorresistência Bacteriana/genética
Feminino
Seres Humanos
Masculino
Testes de Sensibilidade Microbiana
Meia-Idade
Pele/microbiologia
Infecções Estafilocócicas/prevenção & controle
Staphylococcus aureus/efeitos dos fármacos
Staphylococcus aureus/isolamento & purificação
Staphylococcus epidermidis/efeitos dos fármacos
Staphylococcus epidermidis/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiporters); 0 (Bacterial Proteins); 0 (DNA, Bacterial); 0 (Disinfectants); 0 (Membrane Transport Proteins); 0 (QacB protein, Staphylococcus aureus); 0 (small multidrug-resistance pump, Staphylococcus aureus); 134773-66-3 (qacA protein, Staphylococcus aureus); MOR84MUD8E (chlorhexidine gluconate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1099/jmm.0.000463


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[PMID]:29269816
[Au] Autor:Veitz-Keenan A; Ferraiolo DM
[Ad] Endereço:NYU College of Dentistry, New York, USA.
[Ti] Título:Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia.
[So] Source:Evid Based Dent;18(4):113-114, 2017 12 22.
[Is] ISSN:1476-5446
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Data sourcesElectronic databases searched were Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embassy Ovid, LILACS BIREME Virtual Health Library, CINAHL EBSCO, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Database and VIP Database ClinicalTrials.gov and the World Health Organisation International Clinical Trials Registry Platform for ongoing trials. No restrictions on language or date of publication.Study selectionRandomised controlled trials (RCTs) were included evaluating OHC in the form of mouthwashes, swabs or toothbrushing or in combination in critically ill patients receiving mechanical ventilation.Data extraction and synthesisTwo reviewers carried out data extraction independently. Study authors were contacted for additional information. Random-effects meta-analyses were performed where data could be pooled.ResultsThirty-eight RCTs (6,016 participants) were included. Five trials (13%) were assessed at low risk of bias, 26 studies (68%) high and seven studies (18%) of unclear risk of bias. There were four main comparisons; chlorhexidine (CHX mouthrinse or gel) versus placebo/usual care, toothbrushing versus no toothbrushing, powered versus manual toothbrushing and comparisons of oral care solutions.Evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, heterogeneity I2 = 31%). Number needed to treat (NNT) = 17 (95% CI 10 to 33).There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I2 = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I2 = 36%, five RCTs, 800 participants, low quality evidence) or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.The effect of toothbrushing (± antiseptics) is uncertain on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I2 = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I2 = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics).There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I2 = 74%, three studies, 356 participants, high risk of bias) and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P <0.001, I2 = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions.ConclusionsThe results from high quality evidence found that oral hygiene care (OHC), including chlorhexidine mouthwash or gel, reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay.There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
[Mh] Termos MeSH primário: Clorexidina
Pneumonia Associada à Ventilação Mecânica
[Mh] Termos MeSH secundário: China
Seres Humanos
Incidência
Antissépticos Bucais
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Nm] Nome de substância:
0 (Mouthwashes); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:D; IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.1038/sj.ebd.6401272


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[PMID]:27778318
[Au] Autor:Hua F; Xie H; Worthington HV; Furness S; Zhang Q; Li C
[Ad] Endereço:Cochrane Oral Health, School of Dentistry, The University of Manchester, Oxford Road, Manchester, UK, M13 9PL.
[Ti] Título:Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.
[So] Source:Cochrane Database Syst Rev;10:CD008367, 2016 Oct 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs). SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 17 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 11), MEDLINE Ovid (1946 to 17 December 2015), Embase Ovid (1980 to 17 December 2015), LILACS BIREME Virtual Health Library (1982 to 17 December 2015), CINAHL EBSCO (1937 to 17 December 2016), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013) and VIP Database (January 2012 to 4 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 17 December 2015. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We pooled data from trials with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using random-effects models unless there were fewer than four studies. MAIN RESULTS: We included 38 RCTs (6016 participants). There were four main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; toothbrushing versus no toothbrushing; powered versus manual toothbrushing; and comparisons of oral care solutions. We assessed the overall risk of bias as low in five trials (13%), high in 26 trials (68%), and unclear in seven trials (18%). We did not consider the risk of bias to be serious when assessing the quality of evidence (GRADE) for VAP incidence, but we downgraded other outcomes for risk of bias.High quality evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, I = 31%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 17 (95% CI 10 to 33), which indicates that for every 17 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP would be prevented. There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I = 36%, five RCTs, 800 participants, low quality evidence), or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.We are uncertain as to the effects of toothbrushing (± antiseptics) on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics). There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I = 74%, three studies, 356 participants, high risk of bias), and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P < 0.001, I = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions. AUTHORS' CONCLUSIONS: OHC including chlorhexidine mouthwash or gel reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
[Mh] Termos MeSH primário: Estado Terminal
Higiene Bucal/métodos
Pneumonia Associada à Ventilação Mecânica/prevenção & controle
Respiração Artificial/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Criança
Clorexidina/uso terapêutico
Seres Humanos
Unidades de Terapia Intensiva
Antissépticos Bucais/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Escovação Dentária/instrumentação
Escovação Dentária/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Mouthwashes); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1612
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161102
[St] Status:MEDLINE


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[PMID]:29173315
[Au] Autor:Neri I; Ravaioli GM; Faldella G; Capretti MG; Arcuri S; Patrizi A
[Ad] Endereço:Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
[Ti] Título:Chlorhexidine-Induced Chemical Burns in Very Low Birth Weight Infants.
[So] Source:J Pediatr;191:262-265.e2, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Skin disinfection with chlorhexidine gluconate has not been standardized in preterm infants. We present 5 cases of chemical burns that occurred within the first 2 days of life in very low birth weight neonates after skin disinfection with aqueous and alcohol-based chlorhexidine solutions.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/efeitos adversos
Queimaduras Químicas/etiologia
Clorexidina/análogos & derivados
Recém-Nascido de muito Baixo Peso
[Mh] Termos MeSH secundário: Queimaduras Químicas/diagnóstico
Clorexidina/efeitos adversos
Seres Humanos
Recém-Nascido
Recém-Nascido Prematuro
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); MOR84MUD8E (chlorhexidine gluconate); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE



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