Department of Critical Care, University Medical Center Groningen, The University of Groningen, The Netherlands.
Curr Opin Infect Dis. 2012 Apr;25(2):211-7. doi: 10.1097/QCO.0b013e3283507f8c.
This review discusses the relevant studies on selective decontamination of the digestive tract (SDD) published between 2009 and mid-2011.
In a multicenter cluster-randomized cross-over study in the Netherlands, SDD and selective oropharyngeal decontamination (SOD) were associated with higher survival at day 28, with a lower incidence of ICU-acquired bacteremia and with less acquisition of respiratory tract colonization with antibiotic resistant pathogens, compared to standard care. A post-hoc analysis of this study suggests that SDD might be more effective in surgical patients and SOD in nonsurgical patients. In a randomized study perioperative use of SDD in patients undergoing gastrointestinal surgery was associated with lower incidences of anastomotic leakages. A Cochrane meta-analysis, not including any of the before mentioned studies, reported a reduction of respiratory tract infections in studies by using topical antibiotics only and higher survival rates when topical antibiotics were combined with parenteral antibiotics.
Recent studies show that in ICUs with low levels of antibiotic resistance, SDD and SOD improved patient outcome and reduced infections and carriage with antibiotic-resistant pathogens. The effect in settings with higher levels of antibiotic resistance remains to be determined as well as the efficacy of SDD and SOD in specific patient groups.
本综述讨论了 2009 年至 2011 年中期发表的关于消化道选择性去污染（SDD）的相关研究。
在荷兰进行的一项多中心集群随机交叉研究中，与标准治疗相比，SDD 和选择性口咽去污染（SOD）与第 28 天更高的存活率、更低的 ICU 获得性菌血症发生率以及更少的抗生素耐药病原体呼吸道定植有关。对该研究的事后分析表明，SDD 可能对手术患者更有效，而 SOD 对非手术患者更有效。在一项对接受胃肠手术的患者进行围手术期 SDD 的随机研究中，与吻合口漏的发生率较低有关。一项 Cochrane 荟萃分析，未包括上述任何研究，报告仅使用局部抗生素时呼吸道感染减少，局部和全身抗生素联合使用时存活率提高。
最近的研究表明，在抗生素耐药率较低的 ICU 中，SDD 和 SOD 改善了患者的预后，减少了感染和抗生素耐药病原体的携带。在抗生素耐药率较高的环境中的效果仍有待确定，以及 SDD 和 SOD 在特定患者群体中的疗效。
