مجله علمی دانشگاه علوم پزشکی کردستان (Mar 2020)
The effect of combined mouth wash Gentamycine, Colistin and Vancomycine in prevention of Ventilator Associated Pneumonia in mechanical ventilatory patients admitted to intensive care unit: A randomized Clinical Trial
Abstract
Background and Aim: Ventilator-acquired pneumonia is common in invasive mechanical ventilatory patients. There are various methods to prevent and reduce the incidence of ventilator-acquired pneumonia, one of which is the use of combined mouthwashes. The purpose of this study was to evaluate the effect of combined mouthwash on the prevention of ventilator-acquired pneumonia. Materials and Methods: In this clinical-trial study, patients were randomly selected and divided into control and study group. The patients with GCS = 3 and brain death and mechanical ventilation less than 48 hours were excluded from the study. The control group received 0.2% chlorhexidine for mouthwash and the study group received gentamicin 2%, colistin 2% and vancomycin 2%. Mouthwashes were used until the creation of pneumonia symptoms, patient mortality, and endotracheal intubation. Statistical analysis was completed after the study. Results: The incidence of pneumonia was 19 (30.64%) in the study group and 16 (25.8%) in the control group (P = 0.23). In the study group, 39 (62/9%) patients and in the control group 40 patients (64/5%) were discharged (P = 49/0). Cultures endotracheal secretions were reported negatively in 40 patients (5.64%) of study group and 45 patients (58.72%) in control group (P = 0.04). The isolated bacteria in the study group included 11 cases of Acinetobacter (50%), four cases of Pseudomonas (18.18%), two cases of E.coli (9.09%), two cases of Klebsiella (9.09%) and three cases of Gram -positive (16.63%). Also these bacteria were reported as 11 cases of Acinetobacter (64.7%), three cases of Klebsiella (17/64%), two cases of Pseudomonas (11.76%), one case of E.coli (5.9%) in control group (P = 0.001). Conclusion: This study showed that a mouthwash with a combination of Gentamicin-Clestin and Vancomycin, compared to chlorhexidine, was not more effective in preventing ventilator-associated pneumonia in patients undergoing mechanical ventilation.
