Lancet:ICU中选择性脱污染易致抗菌素耐药？
今日，在线发表于《柳叶刀·传染病学》杂志（Lancet Infectious Diseases）的一项荟萃分析研究披露，对重症监护室（ICU）中的患者应用选择性消化道脱污染（SDD）或选择性口咽部脱污染（SOD）与抗菌素耐药病原体（的产生）无关，这表明现有的数据还不足以证实选择性脱污染有长期危害的风险。 Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysisOriginal Text
Dr Nick Daneman MD a b , Syed Sarwar BSc a, Robert A Fowler MD a c, Brian H Cuthbertson MD a c, on behalf of the SuDDICU Canadian Study Group
Summary
Background
Many meta-analyses have shown reductions in infection rates and mortality associated with the use of selective digestive decontamination (SDD) or selective oropharyngeal decontamination (SOD) in intensive care units (ICUs). These interventions have not been widely implemented because of concerns that their use could lead to the development of antimicrobial resistance in pathogens. We aimed to assess the effect of SDD and SOD on antimicrobial resistance rates in patients in ICUs.
Methods
We did a systematic review of the effect of SDD and SOD on the rates of colonisation or infection with antimicrobial-resistant pathogens in patients who were critically ill. We searched for studies using Medline, Embase, and Cochrane databases, with no limits by language, date of publication, study design, or study quality. We included all studies of selective decontamination that involved prophylactic application of topical non-absorbable antimicrobials to the stomach or oropharynx of patients in ICUs, with or without additional systemic antimicrobials. We excluded studies of interventions that used only antiseptic or biocide agents such as chlorhexidine, unless antimicrobials were also included in the regimen. We used the Mantel-Haenszel model with random effects to calculate pooled odds ratios.
Findings
We analysed 64 unique studies of SDD and SOD in ICUs, of which 47 were randomised controlled trials and 35 included data for the detection of antimicrobial resistance. When comparing data for patients in intervention groups (those who received SDD or SOD) versus data for those in control groups (who received no intervention), we identified no difference in the prevalence of colonisation or infection with Gram-positive antimicrobial-resistant pathogens of interest, including meticillin-resistant Staphylococcus aureus (odds ratio 1·46, 95% CI 0·90—2·37) and vancomycin-resistant enterococci (0·63, 0·39—1·02). Among Gram-negative bacilli, we detected no difference in aminoglycoside-resistance (0·73, 0·51—1·05) or fluoroquinolone-resistance (0·52, 0·16—1·68), but we did detect a reduction in polymyxin-resistant Gram-negative bacilli (0·58, 0·46—0·72) and third-generation cephalosporin-resistant Gram-negative bacilli (0·33, 0·20—0·52) in recipients of selective decontamination compared with those who received no intervention.
Interpretation
We detected no relation between the use of SDD or SOD and the development of antimicrobial-resistance in pathogens in patients in the ICU, suggesting that the perceived risk of long-term harm related to selective decontamination cannot be justified by available data. However, our study indicates that the effect of decontamination on ICU-level antimicrobial resistance rates is understudied. We recommend that future research includes a non-crossover, cluster randomised controlled trial to assess long-term ICU-level changes in resistance rates.
Funding
None.
能否翻译一下，使我们这些外语水平差能完全看懂，麻烦了。 不知道有没有全文呀，非常想全文浏览，很好的资料，谢谢楼主 老外思路和发文章的速度真的好快，看来我又得转变一下思路了。 樱木 发表于 2013-1-27 22:47 static/image/common/back.gif
老外思路和发文章的速度真的好快，看来我又得转变一下思路了。
共有64个在ICU中开展的研究被纳入分析，其中47个为随机对照试验；35篇文献检测了抗菌药物耐药
干预组：SDD或者SOD
结果：两组中革兰氏阳性菌的定植和感染率无差异。如MRSA：1.46（0.90-2.37）；VRE：0.63（0.39-1.02）；多粘菌素耐药革兰阴性杆菌0.58（0.46-0.72）和第三代头孢菌素耐药革兰阴性杆菌0.33（0.20-0.52）显著降低。
结论：SDD或者SOD的使用，还不能导致细菌耐药的产生
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