Probiotic Mouthwash May Prevent Ventilator-Associated Pneumonia

A new study describes how using a bacterial solution instead of applying antiseptics is effective in preventing the most common cause of ventilator-associated pneumonia (VAP).

Researchers at the University Hospital Lund (Sweden) carried out a randomized, controlled trial in fifty mechanically ventilated, critically ill patients, comparing a probiotic bacterium--Lactobacillus plantarum 299 (Lp299)--normally present in saliva and also commonly found in fermented food products like pickles and sauerkraut--to the normally used antiseptic chlorhexidine (CHX). The patients were randomized to either oral mechanical cleansing followed by washing with 0.1% CHX solution or to the same cleansing procedure followed by oral application of an emulsion of Lp299. Samples for microbiological analyses were taken from the oropharynx and from the trachea at inclusion and thereafter at defined intervals

The researchers found that the L. Plantarum was just as effective as CHX; potentially pathogenic bacteria that were not present at inclusion were identified in oropharyngeal samples from eight of the patients treated with Lp299 and thirteen of those treated with CHX. Analysis of tracheal samples yielded similar results. Lp299 was recovered from the oropharynx of all patients in the Lp299 group. The researchers explained that the use of the bacteria also had other advantages such as reducing common side effects associated with CHX such as tooth discoloration, irritation, and allergic reactions; moreover, CHX is diluted by saliva and could represent an additional risk by creating resistant strains. The authors claim that the L. plantarum 299 solves these problems, since it is not likely to incorporate resistance genes or plasmids or to transfer genetic material. As the probiotic bacteria adhere to the oral mucosa, they are able to continuously counteract potentially pathogenic bacteria, compared to the short-term effect of orally applied chemical agents. The study was published on November 6, 2008, in the open access journal Critical Care, a publication of BioMed Central (BMC).

"VAP is connected with longer intensive care and hospital stays, additional costs and high mortality. The risk of developing this condition increases by 1% with each additional day of mechanical ventilation,” said lead author Bengt Klarin, M.D., Ph.D. "We hypothesized that swabbing the mouth with probiotics would be an effective (and microbiologically attractive) method of reducing pathogenic oral microorganisms in intubated, mechanically ventilated, critically ill patients.”

Related Links:
University Hospital Lund
BioMed Central