Murthy Srinivas, Pathan Nazima, Cuthbertson Brian H
University of British Columbia, Canada.
University of Cambridge, United Kingdom.
J Crit Care. 2017 Jun;39:169-171. doi: 10.1016/j.jcrc.2017.02.024. Epub 2017 Feb 20.
Selective digestive decontamination of the digestive tract involves the routine administration of oral, gastric, and intravenous antibiotics to mechanically ventilated children to prevent hospital-acquired infections. It has a strong evidence base in adults, with limited pediatric evidence. Current utilization of this intervention among pediatric physicians in North America is unknown.
An electronic survey administered to pediatric critical care and pediatric infectious disease providers in Canada. Participants were surveyed on current institutional practices, their current knowledge of the evidence base, and perceptions of the risks and benefits of the intervention. Descriptive statistics were utilized.
50 out of 143 (35%) surveyed responded. No hospital in Canada routinely performs SDD and the majority of respondents (74%) have neutral opinions on the subject of SDD. There was concern for increasing antibiotic resistance (43%) and some disagreement with the intravenous component of SDD (46%). The majority of respondents stated a need for pediatric-specific evidence before integrating SDD into their practice, even if further, large adult RCTs were performed.
Among surveyed providers, there is little knowledge and no use of selective digestive decontamination for the prevention of hospital-acquired infections. Before interventional studies are performed in pediatric practice, there is a need for study of facilitators, barriers and acceptability of SDD in practice.
消化道选择性去污包括对机械通气儿童常规口服、胃内及静脉给予抗生素，以预防医院获得性感染。其在成人中有充分的证据基础，但儿科证据有限。北美儿科医生目前对该干预措施的使用情况尚不清楚。
对加拿大的儿科重症监护和儿科传染病医疗人员进行电子调查。调查内容包括当前的机构实践、他们对证据基础的了解以及对该干预措施风险和益处的看法。采用描述性统计方法。
143名受访者中有50名（35%）回复。加拿大没有医院常规开展消化道选择性去污，大多数受访者（74%）对消化道选择性去污持中立态度。有人担心会增加抗生素耐药性（43%），并且对消化道选择性去污的静脉用药部分存在一些不同意见（46%）。大多数受访者表示，在将消化道选择性去污纳入实践之前，即使开展更多大型成人随机对照试验，也需要有儿科特异性的证据。
在接受调查的医疗人员中，对用于预防医院获得性感染的消化道选择性去污了解甚少且无人使用。在儿科实践中开展干预性研究之前，需要对消化道选择性去污在实践中的促进因素、障碍和可接受性进行研究。
