Effectiveness of oral hygiene interventions against oral and oropharyngeal reservoirs of aerobic and facultatively anaerobic gram-negative bacilli

• Published in: American journal of infection control 2012-03, Vol.40 (2), p.175-182
• Main Authors: Lam, Otto L.T., BDS, BSc, McGrath, Colman, BA, BDentSc (Hons), FDSRCS, DDPHRCS, MSc, FFDRCS, PhD, Li, Leonard S.W., FRCP, FACRM, FAFRM, FHKCP, FHKAM, Samaranayake, Lakshman P., BDS, DDS, MRCPath, FRCPath, MIBiol, CBiol, FDSRCSE (Hons), FHKCPath, FHKAM (Dental Surgery), FHKAM (Pathology), FCDSHK, Hon DSc
• Format: Article
• Language: English
• Subjects: Anti-Infective Agents, Local - administration & dosage; Antimicrobial agents; Bacteria; Bacteria, Aerobic - drug effects; Bacteria, Anaerobic - drug effects; Biological and medical sciences; Chlorhexidine - administration & dosage; Cross Infection - prevention & control; Disease control; Epidemiology. Vaccinations; General aspects; Gram-negative bacteria; Gram-Negative Bacteria - drug effects; Humans; Infection Control; Infectious Disease; Infectious diseases; Medical sciences; Mouth; Mouth - drug effects; Mouth - microbiology; Nosocomial infections; Oral hygiene; Oral Hygiene - methods; Oropharynx - drug effects; Oropharynx - microbiology; Pathogen; Pneumonia, Bacterial - prevention & control; Povidone-Iodine - administration & dosage
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2011.03.004

Background Aerobic and facultatively anaerobic gram-negative bacilli (AGNB) are opportunistic pathogens and continue to cause a large number of hospital-acquired infections. AGNB residing in the oral cavity and oropharynx have been linked to nosocomial pneumonia and septicemia. Although AGNB are not considered members of the normal oral and oropharyngeal flora, medically compromised patients have been demonstrated to be susceptible to AGNB colonization. Methods A literature search was conducted to retrieve articles that evaluated the effectiveness of oral hygiene interventions in reducing the oral and oropharyngeal carriage of AGNB in medically compromised patients. Results Few studies have documented the use of mechanical oral hygiene interventions alone against AGNB. Although a number of studies have employed oral hygiene interventions complemented by antiseptic agents such as chlorhexidine and povidone iodine, there appears to be a discrepancy between their in vitro and in vivo effectiveness. Conclusion With the recognition of the oral cavity and oropharynx as a reservoir of AGNB and the recent emergence of multidrug and pandrug resistance in hospital settings, there is a pressing need for additional high-quality randomized controlled trials to determine which oral hygiene interventions or combination of interventions are most effective in eliminating or reducing AGNB carriage.