Effect of Oral Application of Povidone-Iodine on the Amount of Viable Bacteria Entering the Lower Respiratory Tract in Intubated Patients With Oral Cancer: A Preliminary Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Nov 25

PMID 39583361

Authors

Akira Imakiire

Sakiko Soutome

Kei-Ichiro Miura

Nanako Ito

Mirai Higaki

Fumitaka Obayashi

Koichi Koizumi

Souichi Yanamoto

Tomohiro Yamada

Masahiro Umeda

Affiliations

Soon will be listed here.

Abstract

One of the causes of ventilator-associated pneumonia (VAP) is the aspiration of fluid-containing pathogenic bacteria into the lower respiratory tract. The purpose of this study was to determine whether oral povidone-iodine (PV-I) application reduces bacterial counts in the fluid on the cuff of an endotracheal intubation tube. Patients intubated and managed with tracheostomy for oral cancer surgery were divided into two groups. The PV-I group received a single topical application of PV-I in the oral cavity. The brushing group underwent tooth brushing with suction and cleaning. Before the intervention, and at one, two, three, and six hours after intervention, samples were taken from the mouth and the cuff to determine viable bacterial counts using the delayed real-time polymerase chain reaction method, which quantifies only viable bacteria. Seven patients in the PV-I group and six in the brushing group were included in the study. The brushing group showed an increase in bacterial counts in both the oral cavity and on the cuff up to six hours post intervention. In contrast, the PV-I group showed significantly lower bacterial counts from one to six hours post intervention, both in the oral cavity and on the cuff. These results indicate that topical PV-I application reduces the number of bacteria entering the lower respiratory tract and may help prevent VAP.

References

Labeau S, Van de Vyver K, Brusselaers N, Vogelaers D, Blot S . Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011; 11(11):845-54. DOI: 10.1016/S1473-3099(11)70127-X. View

Wade W . The oral microbiome in health and disease. Pharmacol Res. 2012; 69(1):137-43. DOI: 10.1016/j.phrs.2012.11.006. View

Hayashida S, Funahara M, Sekino M, Yamaguchi N, Kosai K, Yanamoto S . The effect of tooth brushing, irrigation, and topical tetracycline administration on the reduction of oral bacteria in mechanically ventilated patients: a preliminary study. BMC Oral Health. 2016; 16(1):67. PMC: 4895927. DOI: 10.1186/s12903-016-0224-x. View

Alhazzani W, Smith O, Muscedere J, Medd J, Cook D . Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med. 2012; 41(2):646-55. DOI: 10.1097/CCM.0b013e3182742d45. View

Kollef M, Shorr A, Tabak Y, Gupta V, Liu L, Johannes R . Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005; 128(6):3854-62. DOI: 10.1378/chest.128.6.3854. View

Okano M, Nomura M, Hata S, Okada N, Sato K, Kitano Y . Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989; 125(1):50-2. View

Tsuda S, Soutome S, Hayashida S, Funahara M, Yanamoto S, Umeda M . Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study. BMC Oral Health. 2020; 20(1):62. PMC: 7041202. DOI: 10.1186/s12903-020-1043-7. View

Mojon P . Oral health and respiratory infection. J Can Dent Assoc. 2002; 68(6):340-5. View

Pobo A, Lisboa T, Rodriguez A, Sole R, Magret M, Trefler S . A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest. 2009; 136(2):433-439. DOI: 10.1378/chest.09-0706. View

10.

Chan E, Ruest A, Meade M, Cook D . Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ. 2007; 334(7599):889. PMC: 1857782. DOI: 10.1136/bmj.39136.528160.BE. View

11.

Kobashi Y, Matsushima T . Clinical analysis of patients requiring long-term mechanical ventilation of over three months: ventilator-associated pneumonia as a primary complication. Intern Med. 2003; 42(1):25-32. DOI: 10.2169/internalmedicine.42.25. View

12.

Lorente L, Lecuona M, Jimenez A, Palmero S, Pastor E, Lafuente N . Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis. 2012; 31(10):2621-9. DOI: 10.1007/s10096-012-1605-y. View

13.

Seguin P, Laviolle B, Dahyot-Fizelier C, Dumont R, Veber B, Gergaud S . Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial. Crit Care Med. 2013; 42(1):1-8. DOI: 10.1097/CCM.0b013e3182a2770f. View

14.

Zhao T, Wu X, Zhang Q, Li C, Worthington H, Hua F . Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020; 12:CD008367. PMC: 8111488. DOI: 10.1002/14651858.CD008367.pub4. View

15.

Kerr A, Corby P, Kalliontzi K, McGuire J, Charles C . Comparison of two mouthrinses in relation to salivary flow and perceived dryness. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 119(1):59-64. DOI: 10.1016/j.oooo.2014.09.027. View

16.

Funahara M, Yamaguchi R, Honda H, Matsuo M, Fujii W, Nakamichi A . Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial. BMC Oral Health. 2023; 23(1):917. PMC: 10675882. DOI: 10.1186/s12903-023-03676-7. View

17.

Funahara M, Soutome S, Nakamura A, Soh I, Honda H, Hikiji H . Comparison of the Efficacy of Three Types of Disinfectants Approved for Oral Use in Japan in Reducing the Bacterial Count of Tongue Coating: A Randomised-Controlled Study. Oral Health Prev Dent. 2021; 19:405-409. PMC: 11641061. DOI: 10.3290/j.ohpd.b1749761. View

18.

Imakiire A, Soutome S, Nakamura Y, Nakamatsu M, Miura K, Sakamoto Y . A novel method for determining viable bacteria from a mixture of dead and viable bacteria: Delayed real-time PCR (DR-PCR) method. J Microbiol Methods. 2023; 214:106844. DOI: 10.1016/j.mimet.2023.106844. View

19.

Funahara M, Hayashida S, Sakamoto Y, Yanamoto S, Kosai K, Yanagihara K . Efficacy of topical antibiotic administration on the inhibition of perioperative oral bacterial growth in oral cancer patients: a preliminary study. Int J Oral Maxillofac Surg. 2015; 44(10):1225-30. DOI: 10.1016/j.ijom.2015.06.002. View

20.

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View