de Smet Anne Marie G A, Bonten Marc J M
Department of Anaesthesiology, Division of Perioperative and Emergency Care, University Medical Center Utrecht, The Netherlands.
Curr Opin Infect Dis. 2008 Apr;21(2):179-83. doi: 10.1097/QCO.0b013e3282f60a6c.
The aim of this article is to review relevant studies on the topic of selective decontamination of the digestive tract published in 2006 and 2007.
The only recently published randomized controlled selective decontamination of the digestive tract study failed to demonstrate a benefit of selective decontamination on survival among trauma patients. In fact, two new meta-analyses of selective decontamination of the digestive tract studies were presented: one demonstrated reduced incidences of Gram-negative bacteraemia; in the other no reduction in fungaemia was found. Although selective decontamination of the digestive tract has been associated with increased selection of methicillin-resistant Staphylococcus aureus (MRSA), transmission of MRSA was controlled in a Spanish unit when using selective decontamination in combination with topical vancomycin. Several randomized studies and one meta-analysis suggest that oropharyngeal decontamination with antiseptics is also highly effective in preventing respiratory tract infection in critically ill patients.
The evidence that selective decontamination of the digestive tract improves patient outcome in mixed ICU patients is still based upon meta-analysis and two single centre studies in MRSA-naïve settings. Larger and preferably multicentre studies are needed to confirm these observations. Further remaining questions are whether oropharyngeal decontamination alone is as effective as the full selective decontamination of the digestive tract regimen and whether selective decontamination could be applied successfully in settings with high levels of antibiotic resistance.
本文旨在回顾2006年和2007年发表的关于消化道选择性去污这一主题的相关研究。
最近发表的唯一一项关于消化道选择性去污的随机对照研究未能证明其对创伤患者生存率有益处。事实上，出现了两项关于消化道选择性去污研究的新的荟萃分析：一项显示革兰阴性菌血症的发生率降低；另一项未发现真菌血症减少。尽管消化道选择性去污与耐甲氧西林金黄色葡萄球菌（MRSA）的选择增加有关，但在西班牙的一个单位，当将消化道选择性去污与局部使用万古霉素联合使用时，MRSA的传播得到了控制。几项随机研究和一项荟萃分析表明，用防腐剂进行口咽去污在预防重症患者呼吸道感染方面也非常有效。
消化道选择性去污能改善综合重症监护病房患者预后的证据仍基于荟萃分析以及两项在未接触MRSA环境下进行的单中心研究。需要开展更大规模且最好是多中心的研究来证实这些观察结果。其余尚存的问题是，单独的口咽去污是否与完整的消化道选择性去污方案同样有效，以及消化道选择性去污能否在抗生素耐药性水平较高的环境中成功应用。
