Multicenter Outcomes of Chlorhexidine Oral Decontamination in Intensive Care Units
Background:The efficacy of oral chlorhexidine (oCHG) for decontamination in patients admitted to the intensive care unit (ICU) is variable. The purpose of this study was to evaluate the effect of oCHG decontamination on the incidence of pneumonia (PNA), sepsis, and mortality in ICU patients.
Hypothesis:It was hypothesized that ICU patients recieving oCHG would have lower rates of pneumonia, sepsis, and mortality.
Methods:The Philips eICU database version 2.0 was queried for patients admitted to the ICU in 2014-2015 for at least 48 hours. The primary outcome was ICU mortality. The secondary outcomes were diagnosis of PNA or sepsis. Patients with PNA or sepsis diagnosed within the first 48 hours of ICU admission were excluded from the respective outcome analyses. Univariable analysis was performed using age, gender, race, Acute Physiology Score III, APACHE IVa score, surgical ICU admission status, trauma ICU admission status, intubation status, teaching hospital status, hospital bed size, hospital region, ICU length of stay, and oCHG order. Multivariable logistic regression was performed using univariable outcomes with a p<0.05.
Results:Of the 64,904 patients from 186 different hospitals that met inclusion criteria, 22.1% (n=14,333) had oCHG ordered. The overall mortality rate was 6.9% (n=4,449) and the oCHG mortality rate was 10.6% (n=1,518, p<0.01). After controlling for confounding factors, oCHG remained an independent risk factor for mortality (OR 1.25 [1.16-1.34] p<0.01). After excluding patients with a PNA diagnosis before 48 hours in the ICU, the overall PNA incidence was 2.6% (n=1,431) and the oCHG PNA incidence was 4.2% (n=517, p<0.01). However, multivariable logistic regression revealed no significant difference in risk of PNA with oCHG (OR 0.97 [0.85-1.09] p=0.58). After excluding patients with a sepsis diagnosis before 48 hours in the ICU, the overall rate of sepsis was 1.8% (n=949) and for patients with oCHG the rate of sepsis was 3.3% (n=388, p<0.01). After for controlling for other confounders, oCHG remained an independent risk factor for sepsis (OR 1.37 [1.19-1.59] p<0.01).
Conclusions:Chlorhexidine mouthwash may be associated with an increased risk of mortality and sepsis in ICU patients while not significantly affecting the risk of developing pneumonia. Further randomized, multicenter trials are needed to better understand the effect of oral chlorhexidine on outcomes.