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(4):CD000022. doi: 10.1002/14651858.CD000022.
Pneumonia is an important cause of mortality in intensive care units. The incidence of pneumonia in such patients ranges between 7% and 40%, and the crude mortality from ventilator associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to infections, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths.
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, the Cochrane Acute Respiratory Infections Group trials register, proceedings of scientific meetings and reference lists of articles from January 1984 to December 1999. We also contacted investigators in the field.
Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients.
Investigators were contacted for additional information. At least two reviewers independently extracted data and assessed trial quality.
Overall 33 trials involving 5727 people were included. There was variation in the antibiotics used, patient characteristics and risk of respiratory tract infections and mortality in the control groups. In 16 trials (involving 3361 patients) that tested a combination of topical and systemic antibiotic, the average rates of respiratory tract infections and deaths in the control group were 36% and 30% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.35, 95% confidence interval 0.29 to 0.41) and total mortality (odds ratio 0.80, 95% confidence interval 0.69 to 0.93) in the treated group. On average 5 patients needed to be treated to prevent one infection and 23 patients to prevent one death. In 17 trials (involving 2366 patients) that tested topical antimicrobials the rates of respiratory tract infections and deaths in the control groups were 28% and 26% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.56, 95% confidence interval 0.46 to 0.68) but not in total mortality (odds ratio 1.01, 95% confidence interval 0.84 to 1.22) in the treated group.
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. The design of the trials included in this systematic review does not allow to assess whether or not the treatment leads to antimicrobial resistance. Trials with different design are warranted to reliably address this question.
肺炎是重症监护病房患者死亡的重要原因。此类患者中肺炎的发病率在7%至40%之间，呼吸机相关性肺炎的粗死亡率可能超过50%。虽然这种形式的肺炎患者并非所有死亡都直接归因于感染，但已表明它在重症监护病房中独立于其他也与此类死亡密切相关的因素导致死亡率上升。
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和总体死亡率的影响。
我们检索了1984年1月至1999年12月的医学文献数据库、Cochrane急性呼吸道感染组试验注册库、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。
联系研究人员获取更多信息。至少两名评审员独立提取数据并评估试验质量。
总共纳入了33项涉及5727人的试验。所使用的抗生素、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项试验（涉及3361名患者）中测试了局部和全身联合使用抗生素，对照组呼吸道感染和死亡的平均发生率分别为 36%和30%。治疗组呼吸道感染（优势比0.35，95%置信区间0.29至0.41）和总死亡率（优势比0.80，95%置信区间0.69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项试验（涉及2366名患者）中测试了局部抗菌药物，对照组呼吸道感染和死亡的发生率分别为28%和26%。治疗组呼吸道感染显著降低（优势比0.56，95%置信区间0.46至0.68），但总死亡率未降低（优势比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。本系统综述中纳入的试验设计无法评估该治疗是否会导致抗菌药物耐药性。需要采用不同设计的试验来可靠地解决这个问题。
