Plantinga Nienke L, Bonten Marc J M
University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
Crit Care. 2015 Jun 24;19(1):259. doi: 10.1186/s13054-015-0967-9.
Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.
在抗生素耐药性水平较低的地区，选择性消化道去污（SDD）和选择性口咽去污（SOD）与死亡率降低、ICU获得性菌血症和呼吸机相关性肺炎发生率降低有关。然而，在多重耐药革兰氏阴性菌流行的地区，选择性去污（SDD/SOD）的效果尚不清楚。确定SDD/SOD在这种情况下是否能改善患者预后以及这些措施如何影响多重耐药革兰氏阴性菌的流行病学将非常重要。在此，我们综述了关于SDD/SOD对个体ICU患者抗生素耐药性发展的影响以及对ICU生态影响的现有证据，后者包括ICU层面的抗生素耐药性以及长期使用SDD/SOD期间的抗生素耐药性发展。
