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PubMed1998

Response of single species biofilms and microcosm dental plaques to pulsing with chlorhexidine.

The aim of this study was to determine the effect of pulsing chlorhexidine gluconate, at concentrations commonly used in mouthwashes, on Streptococcus sanguis biofilms and microcosm dental plaques in vitro. Biofilms were grown on bovine enamel and nutrients were supplied in the form of artificial saliva. Pulsing experiments were carried out on steady-state biofilms using 0.05 or 0.2% chlorhexidine solutions delivered twice daily for 1 min. In a separate study, the enamel discs on which the biofilms were formed were pre-treated with chlorhexidine and pulsed directly after inoculation and then at regular intervals. With both concentrations of chlorhexidine used, a c.2 log10 reduction in the viable counts of S. sanguis was achieved with the initial pulse, but as pulsing continued, the bacterial population recovered, albeit not to the previous level. A c.1 log10 reduction in the total viable counts of the microcosm plaques was seen after the first pulse with 0.2% chlorhexidine. The total count then recovered rapidly and, after the fifth pulse, the total viable counts were not significantly different from those before pulsing. The total counts then remained at a similar level throughout the course of the experimental runs. Pre-treatment of the enamel discs with 0.2% chlorhexidine before inoculation produced viable counts of c.10(5) cfu/mm2, a 1 log10 reduction compared with untreated discs. After pulsing with 0.2% chlorhexidine at 8 h, a 3 log10 reduction was seen in the total aerobic and anaerobic counts, but again the viable counts subsequently increased despite twice-daily chlorhexidine pulsing. Regardless of the nature of the biofilm, pulsing initially achieved substantial kills, but the viability of the biofilms subsequently increased despite continued pulsing. Chlorhexidine was effective at reducing the viability of microcosm plaques when it was applied to the substratum before exposure to bacteria and subsequently pulsed on to the biofilms.

Animals↗

PubMed1984

Fluoride enhancement of chlorhexidine uptake by hydroxyapatite and enamel powders.

The purpose of the present study was to examine the in vitro adsorption of chlorhexidine and fluoride to hydroxyapatite and tooth enamel powders. Samples of hydroxyapatite or enamel powder were suspended in aqueous solutions of chlorhexidine gluconate 2.0; chlorhexidine acetate 1.5%; sodium fluoride of various concentrations (0.2%, 1%, 2%) and mixtures of sodium fluoride and chlorhexidine. The data obtained in the study show that chlorhexidine and fluoride adsorb to hydroxyapatite and tooth enamel in vitro. Furthermore, the amount of fluoride adsorbed to hydroxyapatite is reduced in the presence of chlorhexidine in the solution. A probable explanation for this effect may be that there is a competitive adsorption of fluoride and chlorhexidine on to the same binding sites on the hydroxyapatite. Additionally, the presence of fluoride dramatically increases the affinity of chlorhexidine for hydroxyapatite. The fact that fluoride strongly enhanced the adsorption of chlorhexidine to hydroxyapatite and enamel, indicates that fluoride may be of clinical interest beyond the prevention of caries.

Adsorption↗

PubMed2004

Effects of low dose chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide.

BACKGROUND/AIMS: Clinical studies have demonstrated the considerable effects of chlorhexidine on dental plaque and oral microbiota as well as improvements in indices of oral health. This investigation examined the efficacy of lower concentrations of chlorhexidine. METHODS: Mouthrinses with 0.03%, 0.06%, 0.12% chlorhexidine and a control rinse without chlorhexidine were examined. Alamar blue, an oxidation-reduction dye with fluorescent end-points proportional to bacterial viability, was used to determine bacterial viability. Further clinical studies examined the effects of these rinses on salivary bacteria and on bacteria producing hydrogen sulfide (H(2)S) and implicated in halitosis. RESULTS: In laboratory tests, a significant dose-dependent effect was observed with Actinomyces viscosus as a model system using the Alamar blue procedure (P < 0.05). Clinical studies examined the effects 1.5 h and 3 h post-treatment on salivary bacteria and bacteria producing H(2)S. The first study compared the control rinse with the 0.03% and 0.06% chlorhexidine rinses; a second study compared the effects of the control rinse and the 0.06% and 0.12% chlorhexidine mouthrinses. In both studies, chlorhexidine rinses demonstrated significant dose-dependent effects post-treatment on salivary bacteria vs. the control rinse (P < 0.05). Significant decreases in H(2)S-producing bacteria were noted with these chlorhexidine rinses vs. the control rinse (P < 0.05). CONCLUSION: The results highlight the dose-dependent relationships noted in laboratory and clinical tests which have potential implications for the use of lower doses of chlorhexidine to inhibit oral bacteria, including those implicated in halitosis.

Actinomyces viscosus↗

PubMed1988

The mechanism of action of chlorhexidine. A study of plaque growth on enamel inserts in vivo.

Controversy exists concerning the mode of action of chlorhexidine in plaque inhibition. This study attempted to determine whether an oral reservoir of chlorhexidine was necessary for plaque inhibition. Plaque growth on enamel under the influence of topically applied or rinsed chlorhexidine was closely monitored by clinical scoring, bacterial culturing and scanning electron microscopy. Thus, 3 subjects wore removable acrylic appliances containing enamel inserts. In the first regimen, inserts on one side of the appliances were exposed to 0.2% chlorhexidine and on the other, water for 1 min twice a day for 14 days. In the second regimen, subjects rinsed with 0.2% chlorhexidine for 1 min twice a day for 14 days with the appliances in situ. Results demonstrated that plaque growth assessed by the 3 study methods was very small on chlorhexidine-treated inserts by comparison with water-treated specimens. Importantly, inserts treated with chlorhexidine topically or by rinsing could not be distinguished by any method of evaluation. It is concluded that chlorhexidine achieves plaque inhibition as a result of an immediate bactericidal action during the time of application and a prolonged bacteriostatic action as a result of adsorption to the pellicle coated enamel surface. Consistent with other clinical studies, it is apparent that a progressively desorbing oral reservoir of antiseptic is not the mechanism by which chlorhexidine achieves plaque inhibition on teeth.

Administration, Topical↗

PubMed1994

Dose response of chlorhexidine against plaque and comparison with triclosan.

The optimum dose of chlorhexidine delivered by mouthrinse, which balances efficacy against local side-effects, is generally considered to be in the region of 20 mg 2 x daily. Unfortunately, there have been few dose-response studies for chlorhexidine mouthrinses and for these, only limited details are published. The aims of this study were to determine the dose response of chlorhexidine to plaque inhibition and position a 0.1% triclosan rinse within this model. 28 subjects took part in this 7-treatment, double-blind, randomised cross-over 4-day plaque regrowth study. The rinses were 0.01%, 0.05%, 0.1% and 0.2% chlorhexidine, 0.1% triclosan and minus active controls for chlorhexidine and triclosan. On day 1 from a zero plaque baseline, volunteers suspended tooth-cleaning and commenced supervised 2 x daily rinsing with 10 ml volumes of the allocated rinses. On Day 5, plaque was scored by index and area. Treatment differences between the 7 rinses were highly significant. A clear dose-response pattern was seen for chlorhexidine with mean plaque scores decreasing with increasing dose. Even at 0.01%, chlorhexidine showed considerable and significant plaque inhibition compared to control. Triclosan at 0.1% showed limited plaque inhibition and less than 0.01% chlorhexidine. The findings of this study suggest that consideration could be given to low concentration chlorhexidine rinses as adjuncts to oral hygiene.

Adult↗

PubMed1997

The comparative effect of acidified sodium chlorite and chlorhexidine mouthrinses on plaque regrowth and salivary bacterial counts.

Acidified sodium chlorite (ASC) is recognised as a highly potent, broad spectrum antimicrobial system that has been successfully developed for uses in veterinary, food processing and medical device fields. The current studies aimed to investigate the persistence of antimicrobial action and plaque inhibitory properties of 3 ASC mouthrinses by comparison with positive control, chlorhexidine 0.12%, and placebo control, water, rinses. Both studies were randomised, double-blind, cross-over 5-cell designs balanced for carryover. The 1st study involved 15 healthy subjects who immediately before and at 30, 60, 180, 300 and 420 min after rinsing provided 2 ml saliva samples. The samples were immediately processed for total anaerobic bacterial counts recorded after 96 h incubation. Washout periods were a minimum of 3 days. The second study involved 20 healthy subjects who on day 1 of each study were rendered plaque free, suspended normal oral hygiene methods and commenced rinsing twice daily with the allocated rinse. On day 5, plaque was scored by index and area after disclosing with erythrosin. Washout periods were 2 1/2 days. The 3 ASC and chlorhexidine rinses produced similar reductions in salivary bacterial counts which remained significantly below the placebo control to 7 h. There were no significant differences between ASC and chlorhexidine rinses except at 30 and 60 min when significantly greater reductions were produced by 2 ASC rinses compared to the chlorhexidine rinse. Plaque indices and areas were considerably and significantly lower with the ASC and chlorhexidine rinses compared to the placebo rinse. There were no significant differences between plaque scores for the 3 ASC rinses and the chlorhexidine rinse, although for 2 ASC rinses plaque scores were lower than for the chlorhexidine rinse. The results indicate that the 3 ASC rinses have equivalent plaque inhibitory action to chlorhexidine as a rinse. Similar to chlorhexidine, the plaque inhibitory action of the rinses appears to be derived from a persistence of antimicrobial action in the mouth.

Anti-Infective Agents, Local↗

PubMed1998

The inhibitory effect of combining chlorhexidine and hydrogen peroxide on 3-day plaque accumulation.

In a blind, randomised, 4-cell, cross-over study, the effect of rinsing with a perborate solution (1.9 g sodium perborate-monohydrate dissolved in 30 ml water/Bocasan, Oral-B) on the in vivo plaque-inhibiting effect of 0.12% chlorhexidine (Oral-B) was examined. After a thorough professional prophylaxis including interdental cleaning, 12 subjects started to rinse according to 4 different regimens: regimen (C-P-C): chlorhexidine in the morning, perborate at noon and chlorhexidine in the evening; regimen (CP-CP): chlorhexidine immediately followed by perborate in the morning and in the evening; regimen (PC-PC): perborate immediately followed by chlorhexidine in the morning and in the evening; regimen (C-C): chlorhexidine in the morning and in the evening. No further oral hygiene measures were allowed for the next 72 h. After 72 h, the subjects were scored for plaque, and a washout period of 4 days followed; cross-over was randomly assigned according to a Latin square design. Following this procedure, all subjects went through all 4 regimens. The regimens C-P-C and PC-PC resulted in significantly lower plaque-scores, 0.27 and 0.28 respectively, than regimen C-C (0.40). For the regimen CP-CP, the plaque-score was 0.28, which was not significantly different from the C-C regimen. The results suggest a positive interaction between chlorhexidine and hydrogen peroxide. Rinsing with a combination of 0.12% chlorhexidine (Oral-B) and a perborate solution (Bocasan Oral-B) can result in more effective short-term plaque growth inhibition than rinsing with chlorhexidine alone.

Adult↗

PubMed1990

Further in vivo studies on the plaque-inhibiting effect of chlorhexidine and its binding mechanisms.

The aim of the present study was to investigate the relative importance of chemical groups in the oral cavity which bind chlorhexidine of clinical significance. This was performed by clinical experiments where a test panel of 11 individuals rinsed with chlorhexidine at pH 7, pH 5.5, and pH 3. Rinsing with 0.02 M EDTA was performed prior to the chlorhexidine rinse, because this procedure has been shown to enhance the antibacterial effect of chlorhexidine in vitro. However, pre-rinses with EDTA did not increase the clinical effect of chlorhexidine. Bacteriologic tests showed comparable antibacterial effect of chlorhexidine at pH 7 and pH 3. Mouthrinses of pH 7 and pH 5.5 had comparable plaque-inhibiting effects, whereas the effect of a rinse of pH 3 was not different from that of the placebo. This finding is interpreted to suggest that primary phosphate (pK about 2) is an important receptor site for chlorhexidine, whereas secondary phosphate (pK = 7.0) is of negligible importance. Previous studies have clearly shown that phosphate binds chlorhexidine. The lack of clinical effect at pH 3 is probably due to precipitation of salivary proteins by hydrogen ions, making primary phosphate groups unavailable for interaction with chlorhexidine.

Adult↗

PubMed2005

An in vitro model of chlorhexidine-induced tooth staining.

BACKGROUND: Tooth staining is a common feature of chlorhexidine treatment for periodontal disease and there is a large variation between patients as to the degree of their tooth staining. Although the mechanism of tooth staining is uncertain, diet, smoking and oral hygiene appear probable factors. OBJECTIVES: This study investigated the role of saliva in chlorhexidine-induced tooth staining and used tea as the staining agent in an in vitro model with hydroxyapatite mimicking teeth. METHODS: Saliva has been used to create an acquired pellicle and in solution to mimic its effects in vivo. Using different combinations of tea, chlorhexidine and parotid saliva, substances binding to hydroxyapatite were analysed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Using this system, tea, chlorhexidine and salivary proteins were clearly identifiable following staining by Coomassie Brilliant Blue. RESULTS: The results indicated that tea interacted with many salivary proteins, in particular proline-rich proteins and histatins. Chlorhexidine did not appear to complex with or precipitate salivary proteins nor prevent the formation of an acquired pellicle on the hydroxyapatite. In isolation, tea and chlorhexidine bound in small amounts to hydroxyapatite, but when added in combination, binding of both to hydroxyapatite was greatly increased. The acquired pellicle reduced chlorhexidine and tea binding, but conversely increased the binding of either tea or chlorhexidine alone to hydroxyapatite. CONCLUSION: In conclusion, salivary proteins play an important role in the staining process and the combination of tea and chlorhexidine appears to be a very potent staining factor.

Anti-Infective Agents, Local↗

PubMed1989

Elemental surface concentration ratios and surface free energies of human enamel after application of chlorhexidine and adsorption of salivary constituents.

In vitro adsorption of chlorhexidine from a commercially available chlorhexidine-containing (0.12%) mouthrinse (Peridex) on both ground and polished and on saliva-coated enamel was studied by X-ray photoelectron spectroscopy and contact angle measurements. Furthermore, adsorption of salivary constituents was studied on chlorhexidine-treated enamel. Changes in the elemental surface composition obtained by X-ray photoelectron spectroscopy clearly demonstrated adsorption of chlorhexidine from the mouthrinse as indicated by increased N and C signals which were in all cases accompanied by a higher enamel surface free energy, estimated from the contact angle data. In addition, it was found that salivary constituents adsorb less to chlorhexidine-treated enamel than to ground and polished enamel and, moreover, that adsorbed salivary constituents were desorbed by chlorhexidine. In vivo, the effect of a 3-week use of chlorhexidine was compared with the use of a placebo and habitual oral hygiene of 10 volunteers by means of clinical contact angle measurements. Also in vivo adsorption of chlorhexidine yielded elevated surface free energies with respect to habitual oral hygiene or a placebo. Thus in vivo, the well-known favourable effects of the bactericidal properties of chlorhexidine completely overrule the unfavourable effects of high enamel surface free energies.

Adsorption↗

PubMed1991

Influence of contact time and concentration of chlorhexidine varnish on mutans streptococci in interproximal dental plaque.

This study describes the effects of varnishes containing 0, 25, 33 and 40% chlorhexidine diacetate on mutans streptococci in human approximal dental plaque. The chlorhexidine release from the varnishes was determined in vitro. Eleven subjects participated in the clinical experiment, each with at least five approximal areas harboring high levels of mutans streptococci. The approximal areas in each of the individuals were randomly assigned to five experimental groups, in each of which one of the varnishes was tested; 40% chlorhexidine varnish was tested in two experimental groups. The varnish treatment consisted of a single application of a small amount of varnish onto the selected approximal areas. From one of the sites receiving the 40% chlorhexidine varnish, all visible varnish was removed 15 min after application. The volunteers were asked to leave the varnish on the remaining treated sites and not to brush their teeth for 8 h. All chlorhexidine varnishes strongly suppressed mutans streptococci until 4 months after the varnish application. The extent of the suppression depended upon the concentration of chlorhexidine in the varnish, 40% chlorhexidine varnish giving the greatest suppression of mutans streptococci. No significant difference was found between the numbers of mutans streptococci from sites where the 40% varnish was removed after 15 min and sites where the 40% chlorhexidine varnish was left. The results suggested that 40% chlorhexidine varnish can be used successfully for the long-term suppression of mutans streptococci. A contact time of the varnish with the tooth surface of only 15 min is sufficient to achieve this long-term suppression.

Administration, Topical↗

PubMed1989

Effects of sustained-release chlorhexidine acetate on the human dental plaque flora.

The aim of this study was to determine the effect on the human dental plaque flora of a varnish containing chlorhexidine diacetate. The in vitro release of chlorhexidine acetate from the varnish preparation was relatively fast on the first day, followed by a substantial decline in the subsequent three days. In a clinical experiment, 26 volunteers were randomly distributed over four experimental groups. After a dental prophylaxis, the subjects were treated with a single application of a placebo varnish (group I), a fluoride varnish (group II), a chlorhexidine varnish (group III), or a fluoride-plus-chlorhexidine varnish (group IV). Saliva and pooled plaque samples from approximal surfaces were taken before (baseline) and one, two, three, four, and six weeks after the treatments. No suppression was found of total cultivable flora or S. sanguis after the experimental treatments. Application of the fluoride varnish did not suppress the A. viscosus/naeslundii or S. mutans levels in the dental plaque. Chlorhexidine suppressed A. viscosus/naeslundii until two weeks after the treatment. S. mutans was significantly suppressed until four weeks after a single chlorhexidine application. While in some subjects S. mutans was effectively suppressed over the whole experimental period, in others S. mutans recovered quickly. In five subjects in whom S. mutans recovered quickly, the dentition was treated twice with chlorhexidine varnish, with an interval of one week between the treatments. After two chlorhexidine treatments, S. mutans in saliva and on the teeth was suppressed more strongly than after a single treatment. However, the second chlorhexidine treatment could not prevent the return of S. mutans in the approximal areas to its original level.

Actinomyces↗

PubMed2000

Cytotoxicity and teratogenicity of chlorhexidine diacetate released from hollow nylon fibres.

Intra-uterine contraceptive devices are associated with an increased incidence of pelvic infections, possible due to the introduction of vaginal bacteria into the uterus at insertion. One potential means to overcome this problem is the use of a device which releases the antimicrobial agent chlorhexidine although such an approach carries with it the risk of adverse effects on the endometrium and, possibly, teratogenic effects. Cultured monolayers of endometrial cells were used to assess the cytotoxicity of both chlorhexidine and chlorhexidine-releasing devices. The results indicated that the agent is toxic at concentrations of 1 microg mL(-1) and that the devices potentiated the toxicity. When the devices were tested in a guinea-pig model, endometrial damage was seen only at the high dose of chlorhexidine, suggesting that there is greater distribution of chlorhexidine in-vivo. Assessment of the teratogenic effects of chlorhexidine in rat embryonic limb bud tissue cells in-vitro showed that the foetal cells were highly susceptible to the toxic effects of chlorhexidine, but that there was no evidence of teratogenicity. Overall, the findings suggest that chlorhexidine-releasing devices may be a safe means of reducing infections related to intra-uterine devices, but that the chlorhexidine may have a toxic effect on foetal cells.

Animals↗

PubMed1980

Plaque inhibiting effect of combinations of chlorhexidine and the metal ions zinc and tin. A preliminary report.

Rinsing experiments with combinations of chlorhexidine, zinc- and stannous ions were performed in a group of students. Chlorhexidine and zinc (0.2% and 0.3% respectively) gave a plaque inhibiting effect slightly better than chlorhexidine alone, whereas chlorhexidine and stannous ions in the same concentrations showed a reduced effect, presumably due to the low pH of the solution. Pre-rinses with metal ions caused a marked reduction in the effect of chlorhexidine, whereas chlorhexidine first and metal ions afterwards gave approximately the same effect as chlorhexidine alone. The results indicate that the metal ions and chlorhexidine have the same receptor sites in the oral cavity, chlorhexidine exhibiting the stronger affinity when the ions were applied together.

Chlorhexidine↗

PubMed1990

[A evaluation of chlorhexidine as an endosonic irrigan].

Chlorhexidine has been utilized as a root canal irrigant since 1971. It is a broad-spectrum antimicrobial agent with minimal toxicity and residual long-term antibacterial capability. Although a sodium hypochlorite solution has been shown to have a better antimicrobial effect than chlorhexidine, its corrosive effect has prevented its further use especially since the in vitro antimicrobial effect of chlorhexidine has been shown to not be much less. However, the efficacy of chlorhexidine as an endodontic irrigant and intracanal medicament, requires further research in vivo. Therefore, in this study, the clinical effects of chlorhexidine were evaluated by comparing its antimicrobial properties with other endodontic irrigants. One hundred and fifty teeth were selected and evenly divided into 6 groups according to their pathological status. The root cancals were prepared with conventional hand filing or ultrasonic filing, respectively, and were rinsed singly with either chlorhexidine, EDTA or distilled water. The contents of each root canal before or after debridement were cultured in an incubator. The results showed that chlorhexidine with hand filing in one week and with endosonics in 48 hours had a better antimicrobial effect than did EDTA. As compared with the control group (distilled water), chlorhexidine showed marked antimicrobial effect in both hand and endosonic filing. It is concluded that chlorhexidine has an antibacterial effect as an endodontic irrigant in clinical applications.

Bacteria↗

PubMed1988

Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse.

Conditioning chemoradiotherapy damages the mucosal barrier of the mouth and throat and often produces severe oral inflammation and infection. In a prospective, double-blind, randomized study, we examined the use of a chlorhexidine digluconate mouthrinse for prophylaxis against oral mucosal complications in 51 bone marrow transplant patients. Use of chlorhexidine mouthrinse produced significant reductions in the incidence and severity of oral mucositis. Mucositis also resolved more quickly in patients receiving chlorhexidine. Concomitant reductions in total oral streptococci (p less than 0.02-p less than 0.001) and oral candida (p less than 0.004) were seen in patients using chlorhexidine. Persistent clinical oral candidiasis (thrush) was observed in 15 to 27 control group patients (56%), but only transiently in two (8%) of 24 patients who used chlorhexidine rinse (p less than 0.001). Five of 27 control group patients (19%) had candidemia, while no candidemia was observed in the chlorhexidine group (p less than 0.03). Three deaths from disseminated candidiasis occurred in the placebo group; none occurred in patients who received chlorhexidine. Prophylactic use of chlorhexidine mouthrinse produces reductions in oral soft tissue disease and oral microbial burden in patients undergoing bone marrow transplantation. The reductions in mucositis and in oral candida infections observed with prophylactic chlorhexidine mouthrinse represent a significant advantage for patients undergoing marrow transplantation.

Adolescent↗

PubMed2000

Chlorhexidine lavage in the treatment of experimental intra-abdominal infection.

HYPOTHESIS: Closed postoperative peritoneal lavage (CPPL) with chlorhexidine gluconate reduces the number of intraperitoneal bacteria and improves the outcome of intra-abdominal infection. DESIGN: Laboratory animal trial. INTERVENTIONS: Intra-abdominal infection was produced in mice by the cecal ligation and puncture technique. After 16 to 18 hours, the animals underwent relaparotomy and placement of an intra-abdominal catheter for CPPL. In the first experiment animals were randomly divided into 4 groups: no lavage (served as a control), CPPL with chlorhexidine. CPPL with cefoxitin, and CPPL with lactated Ringer solution (LR). Lavage was continued intermittently every 8 hours for 24 hours. All animals received systemic cefoxitin every 8 hours for 7 days. Mortality was recorded every 8 hours for 10 days. In the second experiment, animals were divided into 3 groups: no lavage (served as a control), CPPL with chlorhexidine, and CPPL with LR. Lavage was continued intermittently every 8 hours for 24 hours. The animals were killed 48 hours after reoperation. Bacterial counts from peritoneal fluid and biopsy specimens, as well as peritoneal white blood cell counts, were measured before and after lavage. RESULTS: Closed postoperative peritoncal lavage with chlorhexidine reduced mortality from 71% in a control group to 37% (P = .003). There was no survival benefit in either the CPPL with cefoxitin (91% mortality) (P = .14) or CPPL with LR groups (90% mortality) (P = .17). The statistically significant findings of analysis of variance evaluation demonstrated a decrease in bacterial counts after cecal excision in all 3 groups. There was a greater reduction in bacterial counts in the chlorhexidine group compared with the control group (P<.05). Bacterial counts decreased in peritoneal fluid, as well as in tissue biopsy specimens, after cecal excision. White blood cell counts significantly decreased after cecal excision in all 3 groups. There was no difference in white blood cell counts between the groups. Correlation analyses demonstrated weak interaction between bacterial and white blood cell counts before or after treatment in all the groups. Pearson r ranged from -0.37 to +0.35, none of which were statistically significant. CONCLUSIONS: In our experiments chlorhexidine lavage resulted in a 50% reduction in mortality and a significant reduction in bacterial counts compared with the control group. There was no survival benefit from lavage with either cefoxitin or LR. There was no reduction in bacterial counts in the LR group relative to the control group. Thus, the survival benefit and the reduction in bacterial numbers are attributed to the antibacterial properties of chlorhexidine rather than to the mechanical washing of the abdominal cavity. Closed postoperative peritoneal lavage with 0.05% chlorhexidine gluconate might be useful in the multimodal treatment of intra-abdominal infection.

Animals↗

PubMed2006

Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial.

CONTEXT: Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections. OBJECTIVE: To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12% chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: A prospective, randomized, double-blind, placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands, between August 1, 2003, and September 1, 2005. Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval, 954 were eligible for analysis. INTERVENTION: Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo. MAIN OUTCOME MEASURES: Incidence of nosocomial infection, in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay. RESULTS: The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8% and 26.2%, respectively (absolute risk reduction [ARR], 6.4%; 95% confidence interval [CI], 1.1%-11.7%; P = .002). In particular, lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002; and 3.2%; 95% CI, 0.9%-5.5%; P = .002, respectively). For the prevention of 1 nosocomial infection, 16 patients needed to be treated with chlorhexidine gluconate. A significant reduction of 57.5% in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1% in the placebo group (P<.001). Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group (ARR, 0.8 days; 95% CI, 0.24-1.88; P = .04). CONCLUSION: Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00272675.

Administration, Intranasal↗