去除ICU患者的消化道及口咽部污染，预防性应用抗生素降低ICU死亡率

星火

Preventive Antibiotic Use Reduced ICU Deaths
http://www.medicalnewstoday.com/articles/134319.php
Researchers studying nearly 6,000 patients in intensive care units (ICUs) in 13 hospitals throughout the Netherlands, found that giving antibiotics as a preventive measure to ICU patients increased their chances of survival.

The study was the work of first author Dr. Anne Marie de Smet, an anesthesiologist-intensivist at the Division of Perioperative and Emergency Care of the University Medical Center (UMC) Utrecht in The Netherlands, and colleagues, and is published in the 1 January 2009 issue of the New England Journal of Medicine, NEJM.

Two types of antibiotic treatment are often used to prevent infection in some ICU patients: selective oropharyngeal decontamination (SOD, administered via the mouth) and selective digestive tract decontamination (SDD, straight into the digestive tract). But so far studies examining the effectiveness of these methods have shown conflicting results, wrote the authors in their background information.

For the study, de Smet and colleagues compared standard ICU care with the effect of these two types of antibiotic treatment by putting nearly 5,939 patients into one of these three treatment groups. The patients, who were hospitalized in ICUs between 2004 and 2006, were selected for the study because they were either expected to be be in ICU for at three days and/or to be intubated (on a ventilator) for at least two days.

In the SOD group, 1,904 patients received an oral antibiotic paste four times a day. In the SDD group, 2,045 patients also received the oral paste four times a day plus they were also given antibiotics via a gastric tube into the intestinal tract and also via intravenous drip. In the control group, 1,990 patients received standard ICU care.

The results showed that:
After 4 weeks, fewer patients had died in the antibiotic groups than in the control group (26.6 per cent in the SOD, 26.9 per cent in the SDD, and 27.5 per cent in the control group).

Preventive use of antibiotics in the SDD group reduced deaths by 3.5 per cent, and the SOD group by 2.9 per cent compared to the control group.

There was no significant difference between the two antibiotic groups in measured outcomes.

Also, there was no increase in the number of antibiotic-resistant bacteria among patients in the antibiotics groups.

Although the patients in the control group were in a slightly more serious condition, the researchers took this into account and adjusted the results to rule out this effect.
The authors concluded that:

"In an ICU population in which the mortality rate associated with standard care was 27.5 per cent at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD."

De Smet said the findings are clearly conclusive and help to settle a long running debate about whether the advantages of using antibiotics to prevent infection outweigh the possibility of developing antibiotic resistance.

"I believe we should revise the antibiotic policy for the ICU," said De Smet.

"Because the study was conducted in thirteen Dutch hospitals, the conclusions can be implemented throughout the country. We have seen that using antibiotics clearly results in a reduction in the number of deaths, and ICUs should make use of this knowledge," she added.

However, while these results are promising, the study focused on short term results, and further research is needed to investigate whether resistance to antibiotics would develop in the longer term.

Every year in the Netherlands, more than 18,000 patients spend more than three days in ICUs.

"Decontamination of the Digestive Tract and Oropharynx in ICU Patients."
de Smet, A.M.G.A., Kluytmans, J.A.J.W., Cooper, B.S., Mascini, E.M., Benus, R.F.J., van der Werf, T.S., van der Hoeven, J.G., Pickkers, P., Bogaers -Hofman, D., van der Meer, N.J.M., Bernards, A.T., Kuijper, E.J., Joore, J.C.A., Leverstein-van Hall, M.A., Bindels, A.J.G.H., Jansz, A.R., Wesselink, R.M.J., de Jongh, B.M., Dennesen, P.J.W., van Asselt, G.J., te Velde, L.F., Frenay, I.H.M.E., Kaasjager, K., Bosch, F.H., van Iterson, M., Thijsen, S.F.T., Kluge, G.H., Pauw, W., de Vries, J.W., Kaan, J.A., Arends, J.P., Aarts, L.P.H.J., Sturm, P.D.J., Harinck, H.I.J., Voss, A., Uijtendaal, E.V., Blok, H.E.M., Thieme Groen, E.S., Pouw, M.E., Kalkman, C.J., Bonten, M.J.M.
New England Journal of Medicine, NEJM January 1, 2009, Vol 360, Number 1, pages 20 - 31.
丁香园D3D编译


预防性应用抗生素可降低ICU死亡率

AAAA通过对荷兰13所医院6000名入住ICU患者的研究，研究人员发现预防性应用抗生素可提高患者存活率。研究负责人是来自荷兰乌德勒支大学医学中心围手术期及急救部的麻醉学专家、加强护理学专家Anne Marie de Smet博士，研究成果刊登在2009年1月1日出版的新英格兰医学杂志上。
AAAA通常在ICU中使用预防性使用抗生素的方式有两种：一是选择性口咽部去污染（SOD，口腔局部使用抗生素），二是选择性消化道去污染（SDD，消化道内使用抗生素）。作者在谈到这项研究的背景治疗时表示，根据现有的研究结果，这两种方法的效果众说纷纭。在这项研究中，de Smet和他的同事将5939名ICU患者分为3组，分别为SOD组、SDD组以及对照组（标准ICU治疗治疗而不预防性使用抗生素），并进行比较。这些患者的入选标准是：2004-2006年期间，预期入住ICU时间大于等于3天或行气管插管（机械通气）至少2天的病人。SOD组共计1904例，使用口腔抗生素软膏4次/日。SDD组共计2045例，使用口腔抗生素软膏4次/日并接受胃管内注射抗生素及静脉使用抗生素。对照组共计1990例，接受标准ICU治疗护理。
AAAA结果显示：4周之后，预防性应用抗生素的两组患者死亡率较对照组低（SOD组26.6%、SDD组26.9%，对照组27.5%）。与对照组相比，预防性应用抗生素的SDD组死亡率降低了3.5个百分点而SOD组降低了2.9个百分点。预防性应用抗生素的两组之间，结果并无显著性差异。同时，在预防性应用抗生素两组中也未观察到耐药菌检出率升高的现象。考虑到对照组的患者病情要稍重一些，研究人员对结果进行了校正以排除这一因素的影响。
AAAA“接受标准ICU治疗护理的患者入住28日后的死亡率为27.5%，而通过使用SDD及SOD可使死亡率分别想将3.5及2.9个百分点。”在De Smet看来，“研究结果非常明确，并有助于解决长期以来预防性抗生素应用中患者获益程度及耐药菌产生的争论。”De Smet也确信，应当调整ICU使用抗生素的策略。“在荷兰有13所医院参与了这项研究，因此研究的结论可以在全国范围内推广。我们可以看出预防性应用抗生素确切降低了患者的死亡率，作为ICU医生应当懂得并运用这一理论。”她补充道。
然而，尽管研究结果前景光明，但此研究主要关注短期结果，需要行更进一步的研究以证实长期预防性应用抗生素是否会诱导细菌耐药。
AAAA在荷兰，每年有超过18000名患者入住ICU时间超过3天。
AAAA“去除ICU患者的消化道及口咽部污染”

星火

一是选择性口咽部去污染（SOD，口腔局部使用抗生素），二是选择性消化道去污染（SDD，消化道内使用抗生素）.
在感控中预防性应用抗生素可降低ICU死亡率，是否为感染管理提出了循证依据呢？

hzx

我院口腔护理一直使用“口泰”（甲硝唑+洗必泰），应该说也是SOD一种方式。ICU有1名97岁气插6个月以上的病人，我们做监测以来，没有口腔霉菌、肺部情况稳定，血、胸片没有什么异常。半年多来除了无法拔出插管以外，其他生命体征稳定。 我本来想口泰中含有抗菌素，长期应用是否会对这病人产生耐药菌什么？看了这篇报道，对我启发很大。多谢（星火）管理员。

feifei520

抗生素软膏和口泰哪个便宜些啊。