[Nosocomial pneumonias. The effect of selective intestinal and ventricular decontamination in respirator-treated intensive care patients].
Nosocomial infections, especially pneumonias, are a common problem in Intensive Care Units (ICU) and are a major cause of morbidity and mortality. During the past ten years a new regime, selective decontamination of the digestive tract (SDD) has been introduced to prevent these infections which are often preceded by colonization with aerobic potentially pathogenic microorganisms. Topical antibiotics are applied both orally and by nasogastric tube to prevent secondary endogeneous infections with Gram-negative enteric rods, Staphylococcus aureus and yeasts, in combination with parenteral antibiotics for the treatment of early primarily exogeneous and endogeneous infections. The effect of SDD on morbidity and mortality has been studied in many papers which are very conflicting and their results are difficult to interpret. This article reviews 11 published randomized trials of SDD in ICU among intubated and artificially ventilated adult patients aged more than 15 years. Of the eleven available controlled studies, eight showed a significant reduction of nosocomial pneumonias among patients who received selective decontamination. Only two studies demonstrated a reduction in infection related mortality rates.
Engelsen
J
J
Hillerød Sygehus, anaestesiologisk afdeling.
Jensen
I P
IP
Eriksen
H O
HO
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D011014:Pneumonia / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D011023:Pneumonia, Staphylococcal / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D013270:Stomach / Q000382:microbiology*
D000900:Anti-Bacterial Agents
Nosokomielle pneumonier. Effekten af selektiv dekontaminering af tarm og ventrikel hos respiratorbehandlede intensivpatienter.