Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-05

AUTHORS

Xavier Benoit D’Journo, Pierre-Emmanuel Falcoz, Marco Alifano, Jean-Philippe Le Rochais, Thomas D’Annoville, Gilbert Massard, Jean Francois Regnard, Philippe Icard, Charles Marty-Ane, Delphine Trousse, Christophe Doddoli, Bastien Orsini, Sophie Edouard, Matthieu Million, Nathalie Lesavre, Anderson Loundou, Karine Baumstarck, Florence Peyron, Stephane Honoré, Stéphanie Dizier, Aude Charvet, Marc Leone, Didier Raoult, Laurent Papazian, Pascal Alexandre Thomas

ABSTRACT

PURPOSE: Respiratory complications are the leading causes of morbidity and mortality after lung cancer surgery. We hypothesized that oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate (CHG) would be an effective method to reduce these complications as reported in cardiac surgery. METHODS: In this multicenter parallel-group randomized double-blind placebo-controlled trial, we enrolled consecutive adults scheduled for anatomical pulmonary resection for lung cancer. Perioperative decontamination consisted in oropharyngeal rinse solution (0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary outcome measure was the proportion of patients requiring postoperative invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome measures included occurrence of respiratory and non-respiratory healthcare-associated infections (HAIs) and outcomes within 90 days. RESULTS: Between July 2012 and April 2015, 474 patients were randomized. Of them, 24 had their surgical procedure cancelled or withdrew consent. The remaining 450 patients were included in a modified intention-to-treat analysis: 226 were allocated to CHG and 224 to the placebo. Proportions of patients requiring postoperative MV were not significantly different [CHG 14.2%; placebo 15.2%; relative risks (RRs) 0.93; 95% confidence interval (CI) 0.59-1.45; P = 0.76]. Neither of the proportions of patients with respiratory HAIs were different (CHG 13.7%; placebo 12.9%; RRs 1.06; 95% CI 0.66-1.69; P = 0.81). The CHG group had significantly decreased incidence of bacteremia, surgical-site infection and overall Staphylococcus aureus infections. However, there were no significant between-group differences for hospital stay length, change in tracheal microbiota, postoperative antibiotic utilization and outcomes by day 90. CONCLUSIONS: CHG decontamination decreased neither MV requirements nor respiratory infections after lung cancer surgery. Additionally, CHG did not change tracheal microbiota or postoperative antibiotic utilization. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov, number NCT01613365. More... »

PAGES

578-587

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-018-5156-2

DOI

http://dx.doi.org/10.1007/s00134-018-5156-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1103460790

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29671041


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443 https://www.grid.ac/institutes/grid.483853.1 schema:alternateName Méditerranée Infection Foundation
444 schema:name Centre d’Investigation Clinique, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
445 Service de Chirurgie Thoracique, Chemin des Bourrely, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, 13915, Marseille cedex 20, France
446 Service d’Anesthésie-Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
447 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE),UM63, CNRS 7278, IRD 198 INSERM U1095, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille Aix-Marseille Univ., Marseille, France
448 rdf:type schema:Organization
449 https://www.grid.ac/institutes/grid.5399.6 schema:alternateName Aix-Marseille University
450 schema:name Service Clinique de Pharmacologie, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
451 Unité d’aide méthodologique, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
452 rdf:type schema:Organization
 




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