Department of Clinical and Experimental Medicine, Medical School, University of Catanzaro Magna Græcia, via Tommaso Campanella, 88100 Catanzaro Italy.
Crit Care. 2011 Jun 24;15(3):R155. doi: 10.1186/cc10285.
Given the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients.
A meta-analysis of randomised controlled trials was performed. The U.S. National Library of Medicine's MEDLINE database, Embase, and Cochrane Library computerized bibliographic databases, and reference lists of selected studies were used. Selection criteria for inclusion were: randomised controlled trials (RCTs); primary studies; examining the reduction of VAP and/or mortality and/or all ICU-acquired infections in ICU patients by prophylactic use of one or more of following topical treatments: 1) oropharyngeal decontamination using antiseptics or antibiotics, 2) gastrointestinal tract decontamination using antibiotics, 3) oropharyngeal plus gastrointestinal tract decontamination using antibiotics and 4) respiratory tract decontamination using antibiotics; reported enough data to estimate the odds ratio (OR) or risk ratio (RR) and their variance; English language; published through June 2010.
A total of 28 articles met all inclusion criteria and were included in the meta-analysis. The overall estimate of efficacy of topical SDRD in the prevention of VAP was 27% (95% CI of efficacy = 16% to 37%) for antiseptics and 36% (95% CI of efficacy = 18% to 50%) for antibiotics, whereas in none of the meta-analyses conducted on mortality was a significant effect found. The effect of topical SDRD in the prevention of all ICU-acquired infections was statistically significant (efficacy = 29%; 95% CI of efficacy = 14% to 41%) for antibiotics whereas the use of antiseptics did not show a significant beneficial effect.
Topical SDRD using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research.
由于呼吸机相关性肺炎（VAP）在重症监护病房（ICU）患者中的高发病率和死亡率，预防在机械通气患者的管理中起着关键作用。候选预防干预措施之一是通过局部防腐剂或抗菌剂对消化道或呼吸道进行选择性去污染（SDRD）。我们进行了荟萃分析，以研究用防腐剂或抗生素进行局部消化道或呼吸道去污染对预防 VAP、死亡率和所有 ICU 获得性感染的影响机械通气的 ICU 患者。
对随机对照试验进行荟萃分析。使用美国国立医学图书馆的 MEDLINE 数据库、Embase 和 Cochrane 图书馆计算机书目数据库以及选定研究的参考文献列表。纳入标准为：随机对照试验（RCT）；原始研究；通过预防性使用以下一种或多种局部治疗来检查 VAP 和/或死亡率和/或所有 ICU 获得性感染的降低：1）使用防腐剂或抗生素进行口咽去污染，2）使用抗生素进行胃肠道去污染，3）使用抗生素进行口咽加胃肠道去污染，4）使用抗生素进行呼吸道去污染；报告足够的数据来估计优势比（OR）或风险比（RR）及其方差；英语；发表至 2010 年 6 月。
共有 28 篇文章符合所有纳入标准，并纳入荟萃分析。局部 SDRD 在预防 VAP 方面的总体疗效估计值为防腐剂 27%（95%CI 疗效=16%至 37%）和抗生素 36%（95%CI 疗效=18%至 50%），而在进行的任何一项死亡率荟萃分析中均未发现显著效果。局部 SDRD 在预防所有 ICU 获得性感染方面的效果具有统计学意义（抗生素疗效=29%；95%CI 疗效=14%至 41%），而防腐剂的使用并未显示出显著的有益效果。
使用防腐剂或抗菌剂进行局部 SDRD 可有效降低 ICU 中 VAP 的发生率。与防腐剂不同，局部使用抗生素似乎也能有效预防所有 ICU 获得性感染，而这两种方法对死亡率的有效性需要在进一步的研究中进行调查。
