muramidase and Pneumonia--Ventilator-Associated

Neonatal ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality. In adults on mechanical ventilation, timed oral care decreases the frequency of VAP, but this approach has not been studied in neonates.. To evaluate the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel and estimate the required sample size for such a trial.. Infants were eligible for enrollment if they were born before 28 weeks of gestation, and were mechanically ventilated between 7 and 10 postnatal days. Infants were randomized to receive timed oral care with Biotene OralBalance® gel or sterile water. All subjects were treated with a standard bundle of procedures to reduce the risk of VAP.. We enrolled 41 of 46 eligible infants (89%). Compliance with timed oral care protocol was 97%. No local oral side effects of Biotene OralBalance® gel were observed. There were no significant group differences in mortality or short-term outcomes, except length of hospital stay which was significantly shorter in the Sterile water group (p = 0.02). A lower rate of VAP was found in the Biotene group, although the difference was not statistically significant (9/1000 ventilator-days versus 17/1000 ventilator-days in the Sterile water group, respectively; p = 0.16).. The results of this pilot study support the feasibility of a randomized trial of timed oral care with Biotene OralBalance® gel for prevention of VAP in mechanically ventilated neonates.

Topics: Administration, Topical; Drug Combinations; Feasibility Studies; Female; Glucose Oxidase; Humans; Infant, Extremely Premature; Infant, Newborn; Lactoperoxidase; Length of Stay; Male; Muramidase; Oral Hygiene; Pilot Projects; Pneumonia, Ventilator-Associated; Respiration, Artificial; Treatment Outcome

The study aimed to describe the patterns and density of early tracheal colonization among intubated patients and to correlate colonization status with levels of antimicrobial peptides and inflammatory cytokines.. The was a prospective cohort study.. The study was conducted in medical and cardiovascular intensive care units of a tertiary referral hospital.. Seventy-four adult patients admitted between March 2003 and May 2006 were recruited for the study.. Tracheal aspirates were collected daily for the first 4 days of intubation using standardized, sterile technique and sent for quantitative culture and cytokines, lactoferrin and lysozyme measurements.. The mean acute physiology and chronic health evaluation (APACHE II) score in this cohort was 24 +/- 7. Proportion of subjects colonized by any microorganism increased over the first 4 days of intubation (47%, 60%, 70%, 70%, P = .08), but density of colonization for bacteria or yeast did not change significantly. No known risk factors predicted tracheal colonization on day 1 of intubation. Several patterns of colonization were observed (persistent, transient, new colonization, and clearance of initial colonization).The most common organisms cultured were Candida albicans and coagulase-negative Staphylococcus. Levels of cytokines, lactoferrin, or lysozyme did not change over time and were not correlated with tracheal colonization status. Four subjects (6%) had ventilator-associated pneumonia.. The density of tracheal colonization did not change significantly over the first 4 days of intubation in medical intensive care unit patients. There was no correlation between tracheal colonization and the levels of antimicrobial peptides or cytokines. Several different patterns of colonization may have to be considered while planning interventions to reduce airway colonization.

Topics: Adult; APACHE; Candidiasis; Case-Control Studies; Colony Count, Microbial; Cross Infection; Cytokines; Female; Humans; Inflammation; Intensive Care Units; Intubation, Intratracheal; Lactoferrin; Logistic Models; Male; Middle Aged; Multivariate Analysis; Muramidase; Pneumonia, Ventilator-Associated; Prospective Studies; Respiration, Artificial; Respiratory Mucosa; Risk Factors; Staphylococcal Infections; Statistics, Nonparametric; Suction; Time Factors; Trachea

Oral and oropharyngeal decontamination is one of the main issues for preventing ventilator-associated pneumonia (VAP).. The objective of the study was to detect and compare in vitro antibacterial activities of 3 oral care products (OCP) against major VAP pathogens.. Stabilized hydrogen peroxide (H(2)O(2)); 0.2% chlorhexidine gluconate (CHX); and a commercial product including glucose oxidase, lactoperoxidase, lysozyme, and lactoferrin (GLLL) were selected for this study. In total, 32 VAP isolates were studied by 2 different methods. Bacterial suspension was inoculated onto OCP-absorbed plates in the first method, and OCP was dropped onto bacteria inoculated plates in the second method. Two different bacterial suspensions were used as 10(-2) and 10(-4) dilutions of 0.5 McFarland turbidity.. In the first method, 6 (18%), 6 (18%), and 0 isolates in 10(-2) dilution and 13 (40%), 19 (59.3%), and 2 (6.2%) isolates in 10(-4) dilution of 0.5 McFarland bacterial turbidity were inhibited by CHX, H(2)O(2), and GLLL, respectively. In the second method, 31 (96.8%), 30 (93.7%), and 0 isolates in 10(-2) dilution and 32 (100%), 32 (100%), and 5 (15.6%) isolates in 10(-4) dilution were suppressed. In all dilutions and methods, antibacterial activity of CHX and H(2)O(2) were found more effective than GLLL against VAP pathogens (P < .05).. CHX and H(2)O(2) have good antibacterial effects against most isolated VAP pathogens in vitro. They could be suggested as oropharyngeal decontamination agents for reducing VAP incidence.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Enterobacteriaceae; Glucose Oxidase; Gram-Negative Bacteria; Humans; Hydrogen Peroxide; Lactoferrin; Lactoperoxidase; Microbial Sensitivity Tests; Mouthwashes; Muramidase; Pneumonia, Ventilator-Associated