Should We Screen Patients for Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Intensive Care Units?

Abstract

and could not be imitated. We tried to avoid biases by blinding the observer who determined whether each patient developed VAP. The fact that the incidence of VAP in the intervention group was not statistically significantly different from that in the control group was most likely the result of an inadequate sample size. Therefore, we conducted a meta-analysis and found that 2% chlorhexidine was effective for the prevention of VAP. Moreover, we observed that the rate of VAP (mean number of cases per 1,000 ventilation-days) in the intervention group was significantly less than that in the control group. We focused attention on the clinical importance of the study results (the 50% reduction in the rate of VAP), rather than on the P values (the incidence of VAP was 4.9% in the chlorhexidine and 11.4% in the normal saline group; P = .08). The causative agents of VAP in all study patients were mainly Pseudomonas aeruginosa, Acinetobacter bauman-nii, and Klebsiella pneumoniae. We were concerned about the adverse effects of chlorhex-idine, such as irritation of oral mucosa, as was indicated in our article. 2 We mentioned the factors that might increase the risk of irritation of oral mucosa and warned the healthcare workers who wanted to implement this intervention for their patients. However, we considered that the benefit of VAP prevention outweighed the risk of adverse effects. We believe that the results of the meta-analysis were valid, because we included only the studies that used 2% chlor-hexidine for patients who received mechanical ventilation. The meta-analyses mentioned by Silvestri et al. 1 included studies that used less-concentrated chlorhexidine and included a different population. Although 2% chlorhexidine solution did not significantly decrease mortality among patients who received mechanical ventilation, our intervention was very cost-effective. REFERENCES 1. Silvestri L, van Saene HKF, Milanese M, Zei E, Blazic M. Prevention of ventilator-associated pneumonia by use of oral chlorexidine. Infect Control Hosp Epidemiol 2008; 29:101-102 (in this issue). 2. Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V. Ran-domized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia.