Liberati A, D'Amico R, Pifferi S, Leonetti C, Torri V, Brazzi L, Tinazzi A
Italian Cochrane Centre, Laboratory of Clinical Epidemiology, "Mario Negri Institute", Via Eritrea 62, 20157 Milano, Italy.
Cochrane Database Syst Rev. 2000(2):CD000022. doi: 10.1002/14651858.CD000022.
Pneumonia is an important cause of mortality in intensive care units. The objective of this review was to assess the effects of antibiotics for preventing respiratory tract infections and overall mortality in adults receiving intensive care.
We searched MEDLINE, proceedings of scientific meetings and reference lists of articles from January 1984 to September 1997. We also contacted investigators in the field.
Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients.
Trials were assessed for quality and investigators contacted for additional information.
Overall 33 trials involving 5727 people were included. There was variation in the antibiotics used, patient characteristics and the risk of respiratory tract infections and mortality in the control groups. In 16 trials (involving 3493 patients) of a topical and systemic antibiotic combination, the average rates of respiratory tract infections and deaths in the control group were 33% and 28% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.36, 95% confidence interval 0.30 to 0. 43) and total mortality (odds ratio 0.80, 95% confidence interval 0. 68 to 0.93). On average five patients needed to be treated to prevent one infection and 23 treated to prevent one death. In 17 trials (involving 2366 patients) of topical antimicrobials the rates of respiratory tract infections and deaths in the control groups were 30% and 24% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.57, 95% confidence interval 0.46 to 0.69) but not in total mortality (odds ratio 1.01, 95% confidence interval 0.84 to 1.22).
REVIEWER'S CONCLUSIONS: A combination of topical and systemic prophylactic antibiotics can reduce respiratory tract infections and overall mortality in adult patients receiving intensive care. [This abstract has been prepared centrally.]
肺炎是重症监护病房患者死亡的重要原因。本综述的目的是评估抗生素对预防接受重症监护的成人呼吸道感染及总体死亡率的影响。
我们检索了1984年1月至1997年9月的MEDLINE、科学会议论文集以及文章的参考文献列表。我们还联系了该领域的研究人员。
针对成人重症监护病房患者呼吸道感染和死亡进行抗生素预防的随机试验。
评估试验质量，并联系研究人员获取更多信息。
共纳入33项试验，涉及5727人。所用抗生素、患者特征以及对照组呼吸道感染和死亡风险存在差异。在16项（涉及3493名患者）局部和全身联合使用抗生素的试验中，对照组呼吸道感染和死亡的平均发生率分别为33%和28%。呼吸道感染（比值比0.36，95%置信区间0.30至0.43）和总死亡率（比值比0.80，95%置信区间0.68至0.93）均显著降低。平均每治疗5名患者可预防1例感染，每治疗23名患者可预防1例死亡。在17项（涉及2366名患者）局部使用抗菌药物的试验中，对照组呼吸道感染和死亡的发生率分别为30%和24%。呼吸道感染显著减少（比值比0.57，95%置信区间0.46至0.69），但总死亡率未显著降低（比值比1.01，95%置信区间0.84至1.22）。
局部和全身预防性联合使用抗生素可降低接受重症监护的成年患者的呼吸道感染和总体死亡率。[本摘要由中心统一编写。]
