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Background <p>The role of chlorhexidine in oral care for mechanically ventilated elderly patients remains debated, particularly regarding its impact on oral microbiota and clinical outcomes.</p> Objective <p>To compare oral microbiota composition and prognosis among elderly mechanically ventilated patients receiving oral care with either chlorhexidine solution or normal saline.</p> Methods <p>Sixty intubated patients (≥ 65 years) were randomized to receive oral care with 0.12% chlorhexidine (intervention group) or 0.9% saline (control group) three times daily during mechanical ventilation. All patients underwent standardized oral hygiene during mechanical ventilation. Oral samples were analyzed by 16&#xa0;S rRNA sequencing, with outcomes compared to oral health and clinical data. Secondary outcomes included dental plaque index, ventilator-associated pneumonia (VAP), 28-day mortality, patient outcomes, and oral complications.</p> Results <p>One week after intervention, the chlorhexidine group exhibited a significant decrease in oral bacterial diversity (Simpson index, <i>P</i> = 0.037). Despite this, no significant differences were observed in clinical infection symptoms-defined as fever, purulent airway secretions, elevated white blood cell count, or increased C-reactive protein levels requiring evaluation by the attending physician. All participants received standard ICU antimicrobial prophylaxis or therapy according to institutional protocols; no additional systemic antibiotics were initiated solely for oral or respiratory infections. There were no significant differences between groups in ventilator-associated pneumonia (VAP) incidence (<i>P</i> = 1.000), duration of mechanical ventilation (<i>P</i> = 0.063), ICU stay (<i>P</i> = 0.191), 28-day mortality (<i>P</i> = 0.82), or rates of complications and plaque formation. The chlorhexidine group also showed a decrease in dominant microbial taxa and an increase in specific anaerobic bacteria.</p> Conclusion <p>Chlorhexidine temporarily altered oral microbiota composition without improving short-term clinical outcomes. Although no infections increased, its potential impact on microbial balance warrants caution, and larger studies are needed to validate these findings.</p> Trial registration <p>ClinicalTrials.gov ID NCT06691841. Registeration Date 23 September 2022, <a href="https://clinicaltrials.gov/study/NCT06691841">https://clinicaltrials.gov/study/NCT06691841</a>.</p>

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Effect of chlorhexidine vs. saline for oral care on oral microbiota and prognosis of elderly mechanically ventilated patients in the intensive care unit: a single-center, single-blind, randomized controlled trial

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  • 发表日期：

    2025年12月28日

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  • Changcui Qiu,
  • Lulu Tang,
  • Zhuo Hang,
  • Ke Wei,
  • Sheng Wang,
  • Xiaoping Zhu,
  • Qixing Wang

摘要

Background

The role of chlorhexidine in oral care for mechanically ventilated elderly patients remains debated, particularly regarding its impact on oral microbiota and clinical outcomes.

Objective

To compare oral microbiota composition and prognosis among elderly mechanically ventilated patients receiving oral care with either chlorhexidine solution or normal saline.

Methods

Sixty intubated patients (≥ 65 years) were randomized to receive oral care with 0.12% chlorhexidine (intervention group) or 0.9% saline (control group) three times daily during mechanical ventilation. All patients underwent standardized oral hygiene during mechanical ventilation. Oral samples were analyzed by 16 S rRNA sequencing, with outcomes compared to oral health and clinical data. Secondary outcomes included dental plaque index, ventilator-associated pneumonia (VAP), 28-day mortality, patient outcomes, and oral complications.

Results

One week after intervention, the chlorhexidine group exhibited a significant decrease in oral bacterial diversity (Simpson index, P = 0.037). Despite this, no significant differences were observed in clinical infection symptoms-defined as fever, purulent airway secretions, elevated white blood cell count, or increased C-reactive protein levels requiring evaluation by the attending physician. All participants received standard ICU antimicrobial prophylaxis or therapy according to institutional protocols; no additional systemic antibiotics were initiated solely for oral or respiratory infections. There were no significant differences between groups in ventilator-associated pneumonia (VAP) incidence (P = 1.000), duration of mechanical ventilation (P = 0.063), ICU stay (P = 0.191), 28-day mortality (P = 0.82), or rates of complications and plaque formation. The chlorhexidine group also showed a decrease in dominant microbial taxa and an increase in specific anaerobic bacteria.

Conclusion

Chlorhexidine temporarily altered oral microbiota composition without improving short-term clinical outcomes. Although no infections increased, its potential impact on microbial balance warrants caution, and larger studies are needed to validate these findings.

Trial registration

ClinicalTrials.gov ID NCT06691841. Registeration Date 23 September 2022, https://clinicaltrials.gov/study/NCT06691841.