Tetteroo G W, Wagenvoort J H, Ince C, Bruining H A
Department of Surgery, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Intensive Care Med. 1990;16 Suppl 3:S224-8. doi: 10.1007/BF01709705.
Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections. These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections. We randomised prospectively 114 patients into a test group receiving SD-medication (n = 56) and a control group receiving conventional prophylaxis. Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated. The preoperative administration of SD-medication resulted in adequate decontamination within 3-4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively. Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications. This indicates that prolonged use in these patients might be beneficial. This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.
因癌症接受食管切除术的患者有发生术后呼吸道感染的风险。对这些患者进行了关于革兰氏阴性杆菌先前定植情况的研究，以及选择性去污（SD）在减少这种现象从而降低革兰氏阴性感染方面的效果。我们前瞻性地将114例患者随机分为接受SD药物治疗的试验组（n = 56）和接受常规预防的对照组。术后，所有患者均入住重症监护病房并接受机械通气。术前给予SD药物治疗在大多数患者中3 - 4天内实现了充分去污，并且SD能有效预防革兰氏阴性菌定植和感染。停止SD治疗显示有革兰氏阴性菌（再）定植，并在4例有晚期并发症的患者中导致12次感染。这表明在这些患者中延长使用可能有益。这种新的抗生素预防措施被证明是有效的，且不会导致细菌耐药性增加。
