Pichler H
Wien Klin Wochenschr Suppl. 1976;52:3-24.
132 intensive care patients who did not show symptoms of bacterial infection upon admission were subdivided at random into two groups. 69 patients (37 males, 32 females) were given antibiotic prophylaxis with penicillins or cephalosporins and the remaining 63 patients (37 males, 26 females) did not receive any antibiotic prophylaxis. The average age and the median duration of treatment in the intensive care unit was the same for both groups. 1. Antibiotic prophylaxis neither reduced the infection rate nor the mortality. 2. Pleuropulmonary infections were not influenced in respect to incidence, mortality or time of occurrence by antibiotic prophylaxis. 3. The percentage of patients with gram-negative tracheal flora increased significantly from the third day of antibiotic prophylaxis onwards in comparison with those patients without antibiotic prophylaxis. 4. The incidence of, and mortality attributable to septicaemia was not influenced by antibiotic prophylaxis, but septicaemia in patients receiving antibiotic prophylaxis was significantly delayed. From the seventh day on, septicaemia was found more frequently in patients given antibiotic prophylaxis than in patients receiving none. 5. Patients receiving antibiotic prophylaxis acquired significantly fewer urinary tract infections. However, from the fifth day on, there was no difference between the two groups in regard to the rate of incidence of significant bacteriuria. 6. Morbidity and mortality from peritonitis was not influenced by antibiotic prophylaxis. 7. The organisms causing infections in patients who received antibiotic prophylaxis mostly belonged to the enterobacteriaceae, pseudomonas and candida species which were resistant to the antibiotics given prophylactically. The organisms causing infection in the group not receiving antibiotic prophylaxis were coagulase-positive staphylococci in about 50% of the cases, followed by the enterobacteriaceae and pseudomonas species; the resistance patterns towards the tested antibiotics were characteristic of these groups of organisms. 8. Fever proved to be a reliable parameter in establishing the presence or absence of infection. The mean rectal temperature showed a significant difference in medical patients from the second day, in surgical patients from the third day and im polytraumatized patients from the fourth day on, whereas the mean leucocyte counts did not differ significantly in patients with or without infection. 9. Environmental bacteriological studies in the vicinity of the group of patients given antibiotic prophylaxis showed significantly more gram-negative bacteria than in the group without. However, when the groups were subdivided into intubated and non-intubated patients, a significant rise in environmental gram-negative bacteria was found only in intubated patients receiving antibiotic prophylaxis, whereas no such influence of antibiotic prophylaxis was apparent in the non-intubated patients...
132名入院时未表现出细菌感染症状的重症监护患者被随机分为两组。69名患者（37名男性，32名女性）接受了青霉素或头孢菌素类抗生素预防治疗，其余63名患者（37名男性，26名女性）未接受任何抗生素预防治疗。两组患者在重症监护病房的平均年龄和中位治疗时间相同。1. 抗生素预防治疗既未降低感染率，也未降低死亡率。2. 抗生素预防治疗对胸膜肺部感染的发生率、死亡率或发生时间没有影响。3. 与未接受抗生素预防治疗的患者相比，接受抗生素预防治疗的患者革兰氏阴性气管菌群百分比从预防治疗第三天起显著增加。4. 抗生素预防治疗对败血症的发生率和归因死亡率没有影响，但接受抗生素预防治疗的患者败血症明显延迟。从第七天起，接受抗生素预防治疗的患者比未接受治疗的患者更频繁地发生败血症。5. 接受抗生素预防治疗的患者尿路感染明显较少。然而，从第五天起，两组在显著菌尿发生率方面没有差异。6. 抗生素预防治疗对腹膜炎的发病率和死亡率没有影响。7. 接受抗生素预防治疗的患者中引起感染的微生物大多属于肠杆菌科、假单胞菌属和念珠菌属，它们对预防性使用的抗生素具有耐药性。未接受抗生素预防治疗的组中约50%的病例感染由凝固酶阳性葡萄球菌引起，其次是肠杆菌科和假单胞菌属；这些微生物组对测试抗生素的耐药模式具有特征性。8. 事实证明，发热是确定是否存在感染的可靠参数。平均直肠温度在内科患者从第二天起、外科患者从第三天起以及多发伤患者从第四天起有显著差异，而有感染和无感染患者的平均白细胞计数没有显著差异。9. 对接受抗生素预防治疗的患者组附近进行的环境细菌学研究显示，革兰氏阴性菌明显多于未接受治疗的组。然而，当将两组细分为插管患者和非插管患者时，仅在接受抗生素预防治疗的插管患者中发现环境革兰氏阴性菌显著增加，而在非插管患者中未发现抗生素预防治疗有此类影响……
