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Updated: Aug 9, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind,
D C Bergmans1, M J Bonten, C A Gaillard
1Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands.
Unlabelled:
Colonization of the intestinal tract has been assumed to be important in the pathogenesis of ventilator-associated pneumonia (VAP), but relative impacts of oropharyngeal, gastric, or intestinal colonization have not been elucidated. Our aim was to prevent VAP by modulation of oropharyngeal colonization, without influencing gastric and intestinal colonization and without systemic prophylaxis. In a prospective, randomized, placebo-controlled, double-blind study, 87 patients received topical antimicrobial prophylaxis (gentamicin/ colistin/vancomycin 2% in Orabase, every 6 h) in the oropharynx and 139 patients, divided over two control groups, received placebo (78 patients were studied in the presence of patients receiving topical prophylaxis [control group A] and 61 patients were studied in an intensive care unit where no topical prophylaxis was used [control group B]). Baseline characteristics were comparable in all three groups. Topical prophylaxis eradicated colonization present on admission in oropharynx (75% in study group versus 0% in control group A [p < 0.00001] and 9% in control group B patients [p < 0.00001]) and in trachea (52% versus 22% in A [p = 0.03] and 7% in B [p = 0.004]). Moreover, topical prophylaxis prevented acquired oropharyngeal colonization (10% versus 59% in A [p < 0.00001] and 63% in B [p < 0.00001]). Colonization rates in stomach and intestine were not affected. Incidences of VAP were 10% in study patients, 31% in Group A, and 23% in Group B patients (p = 0.001 and p = 0.04, respectively). This was not associated with shorter durations of ventilation or ICU stay or better survival. Oropharyngeal colonization is of paramount importance in the pathogenesis of VAP, and a targeted approach to prevent colonization at this site is a very effective method of infection prevention.
Keywords:
cross infection, prevention and control; respiration, artificial, adverse effects; antibiotics, administration and dosage infection control methods; pneumonia, etiology, prevention and control; intubation, intratracheal, adverse effects
Insights
Targeting oropharyngeal colonization prevents ventilator-associated pneumonia (VAP). Topical antimicrobial prophylaxis effectively reduced VAP incidence by preventing colonization in the oropharynx without affecting the gut.
Area of Science:
- Critical Care Medicine
- Infectious Disease Epidemiology
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) pathogenesis is linked to microbial colonization.
- The specific role of oropharyngeal, gastric, and intestinal colonization in VAP remains unclear.
- Effective VAP prevention strategies are crucial in intensive care settings.
Purpose of the Study:
- To evaluate the efficacy of topical oropharyngeal antimicrobial prophylaxis in preventing VAP.
- To determine if modulating oropharyngeal colonization impacts VAP rates without altering gastric or intestinal colonization.
- To assess VAP prevention without systemic antibiotic prophylaxis.
Main Methods:
- A prospective, randomized, double-blind, placebo-controlled study involving 87 patients receiving topical oropharyngeal prophylaxis and 139 controls.
- Topical prophylaxis involved gentamicin, colistin, and vancomycin (2%) in Orabase every 6 hours.
- Microbial colonization of the oropharynx and trachea was monitored, alongside VAP incidence.
Main Results:
- Topical prophylaxis significantly eradicated existing oropharyngeal and tracheal colonization and prevented acquired colonization.
- VAP incidence was significantly lower in the topical prophylaxis group (10%) compared to control groups (31% and 23%).
- Gastric and intestinal colonization rates were unaffected by the topical treatment.
Conclusions:
- Oropharyngeal colonization plays a critical role in VAP development.
- Targeted prevention of oropharyngeal colonization is a highly effective strategy for VAP prevention.
- Topical oropharyngeal antimicrobial prophylaxis offers a promising approach to reduce VAP incidence.
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