Oral chlorhexidine and microbial contamination during endoscopy: possible implications for transgastric surgery. A randomized, clinical trial

Donatsky, Anders Meller; Holzknecht, Barbara Juliane; Arpi, Magnus; Vilmann, Peter; Meisner, Søren; Jørgensen, Lars Nannestad; Rosenberg, Jacob

doi:10.1007/s00464-012-2686-5

Cited by 4 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Instead, we found a clear difference in the concentration of gastric bacteria in patients receiving and not receiving therapy and there were a significant number of samples that did not grow bacteria. Furthermore, a study by Donatsky et al 24 determined the change in bacteria concentrations in gastric fluid in adults who did and did not receive an oral decontaminant prior to endoscopy. They found that oral decontamination had no effect on gastric growth, suggesting that oral flora does not have an appreciable effect on gastric fluid flora obtained endoscopically.…”

Section: Discussionmentioning

confidence: 99%

“…They found that oral decontamination had no effect on gastric growth, suggesting that oral flora does not have an appreciable effect on gastric fluid flora obtained endoscopically. 24 Another limitation is that the channel of the scope was not sterile. However, Thorens et al, who collected gastric samples using a sterile tube with a distal rubber cap that was pierced at the time of endoscopy, identified a similar bacterial burden as we did despite different methods of collection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Gastric and Lung Microflora With Acid Suppression

et al. 2014

View full text Add to dashboard Cite

The use of acid suppression has been associated with an increased risk of upper and lower respiratory tract infections in the outpatient setting but the mechanism behind this increased risk is unknown. We hypothesize that this infection risk results from gastric bacterial overgrowth with subsequent seeding of the lungs.OBJECTIVES To determine if acid-suppression use results in gastric bacterial overgrowth, if there are changes in lung microflora associated with the use of acid suppression, and if changes in lung microflora are related to full-column nonacid gastroesophageal reflux. DESIGN, SETTING, AND PARTICIPANTSA 5-year prospective cohort study at a tertiary care center where children ages 1 to 18 years were undergoing bronchoscopy and endoscopy for the evaluation of chronic cough. Acid-suppression use was assessed through questionnaires with confirmation using an electronic medical record review. MAIN OUTCOMES AND MEASURESOur primary outcome was to compare differences in concentration and prevalence of gastric and lung bacteria between patients who were and were not receiving acid-suppression therapy. We compared medians using the Wilcoxon signed rank test and determined prevalence ratios using asymptotic standard errors and 95% confidence intervals. We determined correlations between continuous variables using Pearson correlation coefficients and compared categorical variables using the Fisher exact test.RESULTS Forty-six percent of patients taking acid-suppression medication had gastric bacterial growth compared with 18% of untreated patients (P = .003). Staphylococcus (prevalence ratio, 12.75 [95% CI, 1.72-94.36]), Streptococcus (prevalence ratio, 6.91 [95% CI, 1.64-29.02]), Veillonella (prevalence ratio, 9.56 [95% CI, 1.26-72.67]), Dermabacter (prevalence ratio, 4.78 [95% CI, 1.09-21.02]), and Rothia (prevalence ratio, 6.38 [95% CI, 1.50-27.02]) were found more commonly in the gastric fluid of treated patients. The median bacterial concentration was higher in treated patients than in untreated patients (P = .001). There was no difference in the prevalence (P > .23) of different bacterial genera or the median concentration of total bacteria (P = .85) in the lungs between treated and untreated patients. There were significant positive correlations between proximal nonacid reflux burden and lung concentrations of Bacillus

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in Gastric and Lung Microflora With Acid Suppression

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Chlorhexidine mouthrinse has been commonly used not only in dental practice but also in critical care to prevent ventilator-associated pneumonia [ 20 ]. Moreover, a previous RCT showed that chlorhexidine mouthrinse before gastroscopy was effective in reducing microbial contamination of the endoscope, resulting in an 88% reduction of the median CFU count of wash samples from the working channel of the endoscope [ 16 ]. In this context, we investigated the effect of chlorhexidine mouthrinse on the reduction of microbial contamination during EBUS-TBNA.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was estimated using the results obtained from an RCT of 100 patients who underwent gastroscopy with or without chlorhexidine mouthrinse [ 16 ] because previous studies on CFU counts of TBNA needle wash samples were not available. A sample size of 50 participants per group was required to evaluate whether chlorhexidine mouthrinse reduces the CFU counts of needle wash samples by 50% with an alpha of 0.05 and a power of 90%.…”

Section: Methodsmentioning

confidence: 99%

Effect of chlorhexidine mouthrinse on prevention of microbial contamination during EBUS-TBNA: a randomized controlled trial

Kim

Park

et al. 2022

BMC Cancer

View full text Add to dashboard Cite

Background Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure, fatal infectious complications have been reported. However, adequate preventive strategies have not been determined. We aimed to investigate the effect of chlorhexidine mouthrinse on the prevention of microbial contamination during EBUS-TBNA. Methods In this single-center, assessor-blinded, parallel-group randomized controlled trial, we randomly assigned adult participants undergoing EBUS-TBNA using a convex probe to gargle for 1 minute with 100 mL of 0.12% chlorhexidine gluconate before EBUS-TBNA or to receive usual care (no chlorhexidine mouthrinse). Aspiration needle wash samples were collected immediately after completion of EBUS-TBNA by instilling sterile saline into the used needle. The primary outcome was colony forming unit (CFU) counts per mL of needle wash samples in aerobic cultures. Secondary outcomes were CFU counts per mL of needle wash samples in anaerobic cultures, fever within 24 hours after EBUS-TBNA, and infectious complications within 4 weeks after EBUS-TBNA. Results From January 2021 to June 2021, 106 patients received either chlorhexidine mouthrinse (n = 51) or usual care (n = 55). The median CFU counts of needle wash samples in aerobic cultures were not significantly different in the two groups (10 CFU/mL vs 20 CFU/mL; P = 0.70). There were no significant differences between the groups regarding secondary outcomes, including median CFU counts in anaerobic cultures (P = 0.41) and fever within 24 hours after EBUS-TBNA (11.8% vs 5.6%, P = 0.31). There were no infectious complications within 4 weeks in both groups. Conclusions Chlorhexidine mouthrinse did not reduce CFU counts in needle wash samples of EBUS-TBNA. Trial registration ClinicalTrials.gov, NCT04718922. Registered on 22/01/2021.

show abstract

“…Therefore, antibiotic prophylaxis may be considered in high risk patients, such as in immunocompromised hosts or those with necrotizing, cystic, or calcified lesions, including hypovascular lesions. Gargling with chlorhexidine before the procedure might be also helpful in reducing the risk of bacterial adherence to EBUS-scope[ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Development of mediastinal adenitis six weeks after endobronchial ultrasound-guided transbronchial needle aspiration

Shimada

Furusawa

Ishikawa

et al. 2018

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

A 60-year-old man visited our hospital for further examination of an abnormal chest radiograph. Computed tomography (CT) images revealed enlarged mediastinal lymph nodes and multiple pulmonary nodules.Further evaluation by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed and he was diagnosed with sarcoidosis. Six weeks after EBUS-TBNA, he presented to the emergency department with a high-grade fever. CT scan revealed an enlarged mediastinal lymph node. He was diagnosed with mediastinal adenitis and treated successfully with antibiotics. EBUS-TBNA is a highly accurate diagnostic tool, but clinicians should be aware of mediastinal infectious complication that could be asymptomatic for long period of time.

show abstract

Oral chlorhexidine and microbial contamination during endoscopy: possible implications for transgastric surgery. A randomized, clinical trial

Abstract: Chlorhexidine mouth rinse was effective in reducing microbial contamination of the endoscope, but micro-organisms with abscess forming capabilities were still present. PPI treatment significantly increased CFU and should be discontinued before transgastric surgery.

Cited by 4 publications

References 30 publications

Changes in Gastric and Lung Microflora With Acid Suppression

Changes in Gastric and Lung Microflora With Acid Suppression

Effect of chlorhexidine mouthrinse on prevention of microbial contamination during EBUS-TBNA: a randomized controlled trial

Development of mediastinal adenitis six weeks after endobronchial ultrasound-guided transbronchial needle aspiration

Contact Info

Product

Resources

About