Thülig B, Hartenauer U, Diemer W, Lawin P, Fegeler W, Kehrel R, Ritzerfeld W
Klinik und Poliklinik für Anästhesiologie und operative Intesnivmedizin, Westfälischen Wilhelms-Universität Münster.
Anasth Intensivther Notfallmed. 1989 Dec;24(6):345-54.
The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.
就微生物定植、感染、死亡率和耐药性发展而言，预防性选择性菌群抑制与传统抗生素策略相比是否具有优势？在两个重症监护病房进行了一项前瞻性、连续性、安慰剂对照研究，为期四个6个月周期。纳入研究的患者为200名，他们至少插管3天，至少需要5天的重症监护，并且根据“治疗干预评分系统”属于III级或IV级。他们接受安慰剂或由斯陶滕贝克等人描述的预防方案，该方案由多粘菌素E、妥布霉素和两性霉素B组成。试验组中需氧革兰氏阴性杆菌在口咽、气管支气管和直肠的定植显著减少。医院获得性支气管肺部感染（重症监护病房I和II）和尿路感染（重症监护病房II）的发生率显著降低。伤口感染、败血症和死亡率没有显著降低。未出现耐药性发展，也没有多重耐药菌株增加。选择性菌群抑制在降低重症患者感染率方面有效，且不会产生耐药菌株。
