Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients -: A randomized, double-blind, placebo-controlled, multicenter trial
Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients -: A randomized, double-blind, placebo-controlled, multicenter trial
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DOI：
10.1164/ajrccm.158.3.9712079
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发表时间：
1998-09-01
影响因子：
24.7
通讯作者：
del Castillo, JAS
中科院分区：
文献类型：
--
作者：
García, MS;Galache, JAC;del Castillo, JAS
我们评估了选择性消化道净化（SDD）对混合插管患者人群中呼吸机相关性肺炎（VAP）发病率及其相关发病率和费用的影响。271名连续患者入住五所教学医院的重症监护室（ICU），预期需要插管超过48小时，并接受局部抗生素或安慰剂治疗。未感染的患者另外接受头孢曲松或安慰剂3天。SDD组VAP发生率为11.4%，对照组为29.3%（p < 0.001; 95%可信区间[CI]：7.8 - 27.9）。两组非呼吸道感染的发生率分别为19.1%和30.7%（p = 0.04; 95% CI：0.7 - 22.7）。在存活者中，SDD治疗组的ICU住院时间中位数为11天（四分位数范围：7至21.5天），对照组为16.5天（10至30天）（p = 0.006）。治疗组患者每名幸存者的平均费用为11，926美元，对照组患者为16，296美元。死亡率分别为38.9%和47.1%（p = 0.57）。在净化患者中，革兰氏阴性杆菌的患病率在7天内从47.4%下降到13.0%（p < 0.001），而耐药革兰氏阳性菌株的定植率高于安慰剂组（p < 0.05）。在插管患者的混合人群中，SDD与发病率的显著降低相关，且成本降低。我们的研究结果支持在这一高危人群中使用SDD。
We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16.5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0.05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost, Our findings support the use of SDD in this high-risk group.