O uso de antissépticos bucais tem sido uma das preocupações dos profissionais de saúde considerando a diversidade de produtos, o que traz a insegurança sobre qual é o mais adequado. Objetivou-se avaliar a suscetibilidade de Staphylococcus spp. isolado da saliva de indivíduos adultos da comunidade e do hospital frente a antissépticos bucais. Os antissépticos avaliados foram: solução de Cloreto de Cetilpiridínio, Listerine® e Neen®. Na coleta de saliva para o isolamento do Staphylococcus spp. utilizou-se o swab de alginato de cálcio. O processamento microbiológico envolveu o crescimento, isolamento, identificação das cepas, determinação da DIM. Foi considerada DIM a maior diluição que inibiu completamente as cepas. A eficácia dos produtos foi avaliada por meio da análise de variância (ANOVA) bilateral com medidas repetidas, e pelo método de ajuste de Bonferroni nas comparações múltiplas, com um nível de significância α=0,05. Totalizou-se 80 cepas de Staphylococcus spp. sendo 40 isoladas de pacientes da UTI e 40 de indivíduos da comunidade. Comparando os resultados é possível verificar que a solução de cloreto de cetilpiridínio apresentou melhores resultados em relação aos demais produtos, ou seja, 39 (97,5%) das cepas hospitalares DIM 1:128 e da comunidade 37 (92,5%) DIM 1:64. Para Neen® nos dois grupos a DIM foi de 1:2 e 1:4. Listerine® apresentou o pior resultado em termos da DIM, sendo que 65% das cepas da comunidade e 10% hospitalar não foram inibidas na diluição 1:2.

The use of mouthwashes in critical patients has been a source of concern for health professionals due to the diverse range of products, causing uncertainty about which is the most indicated. This study aimed to assess the susceptibility of Staphylococcus spp. isolated in the saliva of individuals from the community and patients in Intensive Care Units (ICU) as to antiseptic mouthwashes. The following oral antiseptics were assessed: cetylpyridinium chloride solution, Listerine® and Neen®. Calcium alginate swab was used for saliva collection to isolate Staphylococcus spp. Microbiological processing involved growth, isolation, strain identification and determination of MID (maximum inhibitory dilution). MID was considered the greatest dilution that completely inhibited the strains. The products efficacy was analyzed by a two-factor ANOVA repeated measures and by Bonferroni adjustments in multiple comparisons, considering a significance level of α=0.05. In total, 80 strains of Staphylococcus spp. were isolated, 40 from ICU patients and 40 from community individuals. MID results revealed that cetylpyridinium chloride solution presented better results in comparison to other products, that is, 39 (97.5%) strains from hospital patients with MID 1:128, and 37 (92.5%) of individuals from the community had MID 1:64. Neen® inhibited all strains in both groups at a dilution from 1:2 to 1:4. Listerine® presented the worst MID results, 65% of the strains from individuals from the community and 10% of hospital strains were not inhibited at a dilution of 1:2.

Oropharyngeal carriage of Pseudomonas aeruginosa is associated with increased risk of infection and may provide a source for spread of drug-resistant strains. In order to assess the incidence and risk factors of oropharyngeal carriage, we conducted a retrospective cohort study based on results of surveillance cultures (oropharyngeal swabs) from a medical-surgical intensive care unit, collected from March 2005 through May 2006. Variables investigated included demographic characteristics, comorbid conditions, invasive procedures, use of devices and use of antimicrobials. Thirty case patients with P. aeruginosa carriage were identified. Other 84 patients with surveillance cultures negative to P. aeruginosa were enrolled as control subjects. Case patients were more likely to have a solid malignancy (Odds Ratio [OR] = 12.04, 95% Confidence Interval [CI] = 1.93-75.09, p=0.008), Acquired Immunodeficiency Syndrome (AIDS, OR = 7.09, 95% CI= 1.11-45.39, p = 0.04), central nervous system disease (OR = 4.51, 95% CI = 1.52-13.39, p = 0.007), or to have a central venous catheter placed (OR = 7.76, 95% CI = 1.68-35.79, p=0.009). The use of quinolones was a protective factor (OR = 0.13, 95% CI = 0.03-0.47, p = 0.002). The predominance of comorbidities as risk factors points out a group of patients to whom preventive measures should be directed.

A pneumonia associada à ventilação mecânica (PAVM) é uma infecção freqüente nas unidades de terapia intensiva (UTI), e anti-sépticos bucais são utilizados preventivamente. Revisamos metanálises e ensaios clínicos randomizados indexados no Medical Literature Analysis and Retrieval System e Cumulative Index to Nursing and Allied Health Literature sobre o uso tópico da clorexidina na prevenção da PAVM. Oito publicações foram avaliadas. Em sete (87,5%), a clorexidina diminuiu a colonização da orofaringe, e em quatro (50%) houve redução de PAVM. A clorexidina parece diminuir a colonização, podendo reduzir a incidência da PAVM.

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs), and oral antiseptic is used as a preventive measure. We reviewed meta-analyses and randomized clinical trials indexed in the Medical Literature Analysis and Retrieval System and Cumulative Index to Nursing and Allied Health Literature databases regarding the topical use of chlorhexidine in the prevention of VAP. Eight publications were analyzed. In seven (87.5%) chlorhexidine diminished the colonization of the oropharynx, and in four (50%) there was a reduction of VAP. Chlorhexidine seems to reduce colonization, thus reducing the incidence of VAP.