The role of selective decontamination of the digestive tract in acute stroke
The role of selective decontamination of the digestive tract in acute stroke
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DOI：
10.1093/ageing/afj019
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发表时间：
2006-01-01
期刊：
影响因子：
6.7
通讯作者：
Wright, AE
中科院分区：
文献类型：
--
作者：
Gosney, M;Martin, MV;Wright, AE
背景资料：目的：确定急性卒中患者需氧革兰氏阴性菌（AGNB）的定植水平和分离水平，确定选择性消化道去污（SDD）对口腔植物群的影响，以及是否能降低急性卒中后的发病率和死亡率。设计：一个前瞻性的，随机的，安慰剂对照的双盲试验。设置：急性中风评估单位的三家医院在英格兰西北部。主题：203名患者入院后，首次急性中风。方法：参与者被随机分配到SDD口服凝胶或安慰剂。入院时评估吞咽，每周采集三次口腔拭子。人口统计学和临床数据recorded.Results：203例患者（106名男性和97名女性）参加，其中20人在住院期间死亡，19退出和充分的后续行动，获得其余164。从48例患者的105份样本中共分离出122株AGNB。入院时发现吞咽异常58例（29%）。共有34名患者携带一种曾出现过一次或多次的革兰氏阴性微生物。14例患者携带一种以上的AGNB，在治疗的第2周和第3周，安慰剂组比活性组更容易分离出微生物（P = 0.034，卡方）。安慰剂组中的7名患者和治疗组中的1名患者发生肺炎（P = 0.029，Fisher精确检验）。结论：在本研究中发现AGNB的高携带率和定殖率，通过添加SDD降低了AGNB的携带率和定殖率。尽管SDD减少了两种微生物的存在和记录的肺炎发作，但死亡率保持不变。
Background: following a stroke, morbidity and mortality is high, with aspiration pneumonia being a common complication.Objectives: to determine the levels of colonisation by and isolation of aerobic Gram-negative bacteria (AGNB) in acute stroke patients and determine the effect of selective decontamination of the digestive tract (SDD) on oral flora and whether it reduces both morbidity and mortality after an acute stroke.Design: a prospective, randomised, placebo-controlled double blind trial.Setting: acute stroke assessment units of three hospitals in the northwest of England.Subjects: 203 patients admitted to hospital following a first acute stroke.Methods: participants were randomised to SDD oral gel or placebo. Swallow was assessed on admission to hospital, and oral swabs were obtained thrice weekly. Demographic and clinical data were recorded.Results: 203 patients (106 males and 97 females) participated, of whom 20 died during their hospitalisation, 19 withdrew and full follow-up was obtained for the remaining 164. A total of 122 AGNB were isolated in 105 samples from 48 patients. Abnormal swallow on admission was found in 58 patients (29%). A total of 34 patients carried a single gram-negative micro-organism that was present on one or more occasions. More than one AGNB was carried in 14 patients, and organisms were significantly more likely to be isolated from the placebo group than the active group during weeks 2 and 3 of treatment (P = 0.034, chi-squared). Seven patients in the placebo group and one in the treatment group developed pneumonia (P = 0.029, Fisher's exact test).Conclusions: high carriage of and colonisation by AGNB was found within this study, which was reduced by the addition of SDD. Although SDD reduced the presence of both organisms and documented episodes of pneumonia, mortality remained unchanged.