Biagioni Emanuela, Ferrari Elena, Gatto Ilenia, Serio Lucia, Farinelli Carlotta, Coloretti Irene, Talamonti Marta, Tosi Martina, Meschiari Marianna, Tonelli Roberto, Venturelli Claudia, Mussini Cristina, Clini Enrico, Sarti Mario, Cossarizza Andrea, Busani Stefano, Girardis Massimo
Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy.
Infectious Disease Unit, University Hospital of Modena, 41124 Modena, Italy.
J Clin Med. 2023 Feb 10;12(4):1432. doi: 10.3390/jcm12041432.
The aim of our study was to evaluate whether the introduction of SDD in a structured protocol for VAP prevention was effective in reducing the occurrence of ventilator-associated pneumonia (VAP) in COVID-19 patients without changes in the microbiological pattern of antibiotic resistance. This observational pre-post study included adult patients requiring invasive mechanical ventilation (IMV) for severe respiratory failure related to SARS-CoV-2 admitted in three COVID-19 intensive care units (ICUs) in an Italian hospital from 22 February 2020 to 8 March 2022. Selective digestive decontamination (SDD) was introduced from the end of April 2021 in the structured protocol for VAP prevention. The SDD consisted of a tobramycin sulfate, colistin sulfate, and amphotericin B suspension applied in the patient's oropharynx and the stomach via a nasogastric tube. Three-hundred-and-forty-eight patients were included in the study. In the 86 patients (32.9%) who received SDD, the occurrence of VAP decreased by 7.7% ( = 0.192) compared to the patients who did not receive SDD. The onset time of VAP, the occurrence of multidrug-resistant microorganisms AP, the length of invasive mechanical ventilation, and hospital mortality were similar in the patients who received and who did not receive SDD. The multivariate analysis adjusted for confounders showed that the use of SDD reduces the occurrence of VAP (HR 0.536, CI 0.338-0.851; = 0.017). Our pre-post observational study indicates that the use of SDD in a structured protocol for VAP prevention seems to reduce the occurrence of VAP without changes in the incidence of multidrug-resistant bacteria in COVID-19 patients.
我们研究的目的是评估在预防呼吸机相关性肺炎（VAP）的结构化方案中引入选择性消化道去污（SDD）是否能有效降低COVID-19患者呼吸机相关性肺炎（VAP）的发生率，同时抗生素耐药的微生物模式不变。这项观察性前后对照研究纳入了2020年2月22日至2022年3月8日在意大利一家医院的三个COVID-19重症监护病房（ICU）因严重呼吸衰竭需要有创机械通气（IMV）且与SARS-CoV-2相关的成年患者。从2021年4月底开始，在预防VAP的结构化方案中引入了选择性消化道去污（SDD）。SDD包括通过鼻胃管将硫酸妥布霉素、硫酸多粘菌素和两性霉素B悬浮液应用于患者的口咽和胃部。348名患者纳入研究。在接受SDD的86名患者（32.9%）中，与未接受SDD的患者相比，VAP的发生率下降了7.7%（P = 0.192）。接受和未接受SDD的患者在VAP的发病时间、多重耐药微生物VAP的发生率、有创机械通气时间和医院死亡率方面相似。对混杂因素进行调整的多变量分析表明，使用SDD可降低VAP的发生率（HR 0.536，CI 0.338 - 0.851；P = 0.017）。我们的前后对照观察性研究表明，在预防VAP的结构化方案中使用SDD似乎可降低COVID-19患者VAP的发生率，而多重耐药菌的发生率没有变化。
