一、SDD，SOD是否会引起抗菌药物耐药呢？能不能影响患者死亡率改变？
JAMA的最新一期RCT研究给出了证据。文章我已经上传附件了。
可以看到Unit-wide application of SDD and SOD was associated with low levels of antibiotic resistance and no differences in day-28 mortality. Compared with SOD, SDD was associated with lower rectal carriage of antibiotic-resistant gram-negative bacteria and ICU-acquired bacteremia but a more pronounced gradual increase in aminoglycosideresistant gram-negative bacteria.
如果大家有印象相比看过之前LANCET的一片文章，
http://www.ncbi.nlm.nih.gov/pubmed/23352693
Lancet Infect Dis. 2013 Apr;13(4):328-41. doi: 10.1016/S1473-3099(12)70322-5. Epub 2013 Jan 25.
Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review andmeta-analysis.
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. 当时说SDD或者SOD对于AR没有明显的效应。但是需要进一步WELL DESIGNED RCT证实。现在这也是进一步的evidence了。
joi140083.pdf
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发表于 2014-10-9 10:36
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