The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial

Background: Antibiotic prophylaxis to prevent bacterial endocarditis is rec ommended in highrisk patients undergoing esophageal dilation, a high-risk p rocedure. Some studies suggest that the oropharynx is the source of bactere mia. A topical antibiotic mouthwash, which reduces bacterial colonization o f the oral flora, might decrease bacteremia rates and would be an attractiv e alternative to systemic administration of antibiotics. Methods: Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to eith er pre-procedure clindamycin mouthwash or no treatment. Subjects were strat ified by type of dilator used. Blood cultures were obtained immediately aft er the first esophageal dilation and 5 minutes after the last dilation. Results: Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the tre atment arm and 29 in the no-treatment arm. The identified organisms were St reptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2 ), and Actinomyces odontolyticus (1). Patients with bacteremia reported gre ater subjective difficulty with dysphagia (p = 0.01) irrespective of strict ure diameter, procurement of biopsies, or dilator type. Conclusions: The percentage of cases with bacteremia for all dilations perf ormed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previous ly cited. All organisms in this study were oral commensals. There appears t o be no effect of a clindamycin mouthwash on reducing bacteremia after esop hageal dilation.