PREVENTION OF INFECTION IN CRITICALLY ILL PATIENTS BY SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT
PREVENTION OF INFECTION IN CRITICALLY ILL PATIENTS BY SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT
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DOI：
10.7326/0003-4819-117-7-545
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发表时间：
1992-10-01
影响因子：
39.2
通讯作者：
THOMPSON, RL
中科院分区：
文献类型：
--
作者：
COCKERILL, FR;MULLER, SR;THOMPSON, RL
目的：确定使用口服和非吸收性抗菌药物和肠外头孢噻肟对消化道进行选择性去污是否可预防危重患者的感染。设计：随机对照试验，不设盲。设置：三级转诊医院的外科创伤和重症监护室。患者：150名患者在3年的时间间隔内被外科创伤和重症监护室收治，其病情表明需要长期住院干预：患者被随机分配到实验组（n = 75），接受头孢噻肟，每8小时静脉注射1 g，仅在前3天，并在重症监护室的整个住院期间口服不可吸收的抗生素（庆大霉素、多粘菌素和制霉菌素，口服糊剂和口服液）。对照组患者（n = 75）接受常规护理。测量：记录感染人数、总住院天数、死亡人数以及在重症监护室的天数。对照组患者经历了更多的感染细菌感染14例，肺部感染4例，肺部感染14例，肺部感染4例，肺部感染14例，肺部感染4例，肺部感染虽然治疗组的总住院天数、重症监护天数和总死亡率均较低，但这些差异无统计学意义。临床上重要的并发症，选择性去污的消化道没有遇到。结论：选择性去污的消化道降低随后的感染率，特别是革兰氏阴性杆菌，在选定的患者在长期停留在重症监护室。
Objective: To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients.Design: Randomized, controlled trial without blinding.Setting: Surgical trauma and medical intensive care units in a tertiary referral hospital.Patients: One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval, whose condition suggested a prolonged stay (> 3 days).Intervention: Patients were randomly allocated to an experimental group (n = 75) that received cefotaxime, 1 g intravenously every 8 hours for the first 3 days only, and oral, nonabsorbable antibiotics (gentamicin, polymyxin, and nystatin by oral paste and oral liquid) for the entire stay in the intensive care unit. Control patients (n = 75) received usual care.Measurements: The number of infections, total hospital days, and deaths, as well as the number of days in intensive care unit, were recorded.Results: Control patients experienced more infections (36 compared with 12, P = 0.04), including bacteremias (14 compared with 4, P = 0.05) and pulmonary infections (14 compared with 4, P = 0.03). Although total hospital days, days in intensive care, and the overall death rate all were lower in the treatment group, these differences were not statistically significant. Clinically important complications of selective decontamination of the digestive tract were not encountered.Conclusions: Selective decontamination of the digestive tract decreases subsequent infection rates, especially by gram-negative bacilli, in selected patients during long-term stays in the intensive care unit.