Chlorhexidine Oral Rinse to Reduce Perioperative Mortality

Abstract

Nosocomial infections after cardiac surgery are an important cause of mortality, morbidity, prolonged hospital stay, increased need for antimicrobial therapy and higher costs. In particular, ventilator associated pneumonia (VAP) is the most frequent serious infection among patients undergoing heart surgery and is associated with a 15-45% or even higher attributable mortality. Since microaspiration of oropharyngeal secretions contaminated by endogenous flora is the major route for microbial invasion in VAP, oral decontamination with antiseptics, especially chlorhexidine, in order to reduce concentrations of oral microorganisms seems to be one of the most successful interventions for VAP prevention, as reported in literature and suggested by guidelines. Particularly, preoperative and postoperative oral rinse with chlorhexidine has been shown to reduce VAP incidence in cardiac surgery patients and may thus exert a survival benefit, at least in this clinical setting. However, this topic deserves further investigation, also in order to determine the optimal dose (in terms of frequency of application and chlorhexidine concentration). Furthermore, some concerns may exist about the possible development of reduced susceptibility to chlorhexidine.