One of the main pathogenetic mechanisms for the development of respiratory pneumonia (VAP) in most cases is the aspiration of pathogenic microorganisms that colonize the oropharynx. In this regard, as a prophylaxis of this serious complication in patients on mechanical ventilation, decontamination of the oral cavity using antiseptics (eg chlorhexidine) or antibiotics is used.

The aim of an open randomized controlled pilot study was to compare the efficacy of the probiotic Lactobacillus plantarum 299 (Lp299) with chlorhexidine to reduce colonization of the oropharynx by pathogenic microorganisms in extremely seriously ill under mechanical ventilation.

Fifty critically ill patients with mechanical ventilation were randomized into 2 groups: patients in the first group underwent mechanical cleaning of the oral cavity and subsequent treatment with 0.1% chlorhexidine solution, patients in the second group underwent similar treatment of the oral cavity, but a probiotic emulsion was used in place of chlorhexidine Lp299. Oropharynx and trachea samples were taken for microbiological studies at the time of patient inclusion and during the study at regular intervals.

Potential pathogens which were not detected at the time when patients were included in the study were then identified from oropharyngeal samples from 8 patients treated with the probiotic Lp299 and 13 patients treated with chlorhexidine (p = 0.13). Similar indicators were obtained in the analysis of samples from the trachea. With the use of Lp299, no obvious adverse events have been reported.

According to the researchers, the use of the probiotic Lp299 for decontamination of the oral cavity is very interesting from a microbiological point of view, since lactobacilli inhibit the adhesion of potentially pathogenic microorganisms to the oral mucosa 24 hours a day, thus the duration of action of the chemical agents used for this purpose.

In addition, chlorhexidine is diluted and inactivated by saliva, and bacteria can be resistant to chlorhexidine, and the risk of resistance selection and spread increases with the low concentrations of chlorhexidine that occur between hygienic procedures. oral.

Thus, the results of this pilot study demonstrated the absence of differences in the frequency of oropharyngeal colonization by potential pathogens in patients on mechanical ventilation using the probiotic L. for oral hygiene. plantarum 299 and chlorhexidine.