Comparison Effects of Chlorhexidine 0.12%, Povidone Iodine 1%, and Fluoride-Based Toothpaste as Oral Hygiene Agents on the Growth of Tracheal Bacterial Colonization and Antibiotic Resistance in Mechanical Ventilation Patients

Muhammad Fajrin Sulaeman; Faisal Muchtar; . Hisbullah; Syafri Kamsul Arif; Nur Surya Wirawan; Madonna Damayanthie Datu

doi:10.18502/aacc.v12i3.21311

Muhammad Fajrin Sulaeman Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Faisal Muchtar Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
. Hisbullah Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Syafri Kamsul Arif Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Nur Surya Wirawan Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Madonna Damayanthie Datu Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.

DOI: https://doi.org/10.18502/aacc.v12i3.21311

Keywords: Ventilator-associated pneumonia; Oral hygiene; Mechanical ventilation; Antibiotic resistance; Tracheal microorganism colonies

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is a common complication in mechanically ventilated ICU patients and is associated with bacterial colonization in the oral cavity. Poor oral hygiene can increase the risk of bacterial aspiration into the lower airway. Various oral hygiene agents such as chlorhexidine, povidone iodine 1%, and fluoride toothpaste are used to prevent this colonization, but their effectiveness is still variable. This study aimed to compare these three agents on tracheal microorganism growth and antibiotic resistance profile in mechanically ventilated patients.

Methods: This single-blind randomized clinical trial included 45 ICU patients on mechanical ventilation at Dr. Wahidin Sudirohusodo Hospital, Makassar. Subjects were allocated into three groups to receive oral hygiene using chlorhexidine 0.12%, povidone iodine 1%, or fluoride toothpaste twice daily for five days. Tracheal aspirates were collected at baseline (before intervention), Day 3, and Day 5 to assess microbial colony counts and antibiotic susceptibility profiles.

Results: The chlorhexidine group showed the most significant reduction in tracheal microorganism colony counts from 1833.33 566.5 to 1226.7 461.7 CFU/mL on day 5 (p < 0.001), compared to povidone iodine and fluoride. The highest antibiotic resistance was found in Acinetobacter baumannii and Pseudomonas aeruginosa. The chlorhexidine group also had the lowest number of multiresistant isolates.

Conclusion: Among the evaluated oral hygiene agents, chlorhexidine 0.12% was the most effective in reducing tracheal microbial colonization and showed a lower tendency for antibiotic resistance development. It is recommended as a superior oral care agent for preventing VAP in mechanically ventilated ICU patients.