以选择性消化道去污染为自然实验，评估局部抗生素预防和头孢菌素使用作为 ICU 患者肠球菌菌血症的人群水平危险因素。

Studies of selective digestive decontamination as a natural experiment to evaluate topical antibiotic prophylaxis and cephalosporin use as population-level risk factors for enterococcal bacteraemia among ICU patients.

机构信息

Melbourne Medical School, University of Melbourne, Internal Medicine Service, Ballarat Health Services, Ballarat, Victoria, Australia.

出版信息

J Antimicrob Chemother. 2019 Oct 1;74(10):3087-3094. doi: 10.1093/jac/dkz300.

DOI:10.1093/jac/dkz300

PMID:31355880

Abstract

BACKGROUND

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) regimens appear protective against ICU-acquired overall bacteraemia. These regimens can be factorized as topical antibiotic prophylaxis (TAP) with (SDD) or without (SOD) protocolized parenteral antibiotic prophylaxis (PPAP) using cephalosporins. Both TAP and cephalosporins are risk factors for enterococcal colonization although their impact on enterococcal bacteraemia within studies of SDD/SOD remains unclear.

OBJECTIVES

To benchmark the enterococcal bacteraemia incidence within component (control and intervention) groups of SDD/SOD studies among ICU patients versus studies without intervention (observational groups).

METHODS

The literature was searched for SDD/SOD studies reporting enterococcal bacteraemia incidence data. In addition, component groups of studies of various non-antibiotic interventions served to provide additional points of reference.

RESULTS

The mean incidence per 100 patients (and 95% CI) for enterococcal bacteraemia among 19 SDD/SOD studies was equally increased among concurrent control (2.1; 1.0%-4.7%) and intervention (2.3; 2.0%-2.7%) groups versus the benchmark incidence (0.8; 0.6%-1.2%) derived from 16 observational study groups and also versus 9 component groups from non-antibiotic studies. These higher incidences remained apparent (P < 0.02) in a meta-regression model adjusting for groupwide factors such as PPAP use, mechanical ventilation proportion, group mean length of stay >7 days and publication year.

CONCLUSIONS

The incidences of enterococcal bacteraemia within both concurrent control and intervention groups of SDD/SOD studies are unusually high compared with the literature-derived benchmark. The impact of parenteral cephalosporin used as PPAP additional to TAP on enterococcal bacteraemia incidence was indeterminate in this analysis.

摘要

背景

选择性消化道去污染（SDD）和选择性口咽去污染（SOD）方案似乎可以预防 ICU 获得性全身菌血症。这些方案可以分为局部抗生素预防（TAP），包括（SDD）或不包括（SOD）方案的头孢菌素全身抗生素预防（PPAP）。TAP 和头孢菌素都是肠球菌定植的危险因素，尽管它们在 SDD/SOD 研究中对肠球菌菌血症的影响尚不清楚。

目的

在 ICU 患者的 SDD/SOD 研究的对照（对照组）和干预（干预组）组内与无干预（观察组）研究相比，比较肠球菌菌血症的发生率。

方法

检索了 SDD/SOD 研究报告肠球菌菌血症发生率数据的文献。此外，各种非抗生素干预研究的对照（对照组）和干预（干预组）组也为提供了额外的参考点。

结果

19 项 SDD/SOD 研究中，19 项 SDD/SOD 研究中每 100 例患者的平均发生率（95%CI）分别为同期对照组（2.1；1.0%-4.7%）和干预组（2.3；2.0%-2.7%），高于从 16 个观察性研究组获得的基准发生率（0.8；0.6%-1.2%），也高于 9 个非抗生素研究的对照组。在调整了广泛的因素（如使用 PPAP、机械通气比例、组内平均住院时间>7 天和发表年份）的荟萃回归模型中，这些更高的发生率仍然明显（P < 0.02）。