Späth G
Chirurgische Klinik und Poliklinik, Rheinische Friedrich-Wilhelms-Universität, Bonn.
Zentralbl Chir. 1995;120(6):417-25.
After giving an overview on the epidemiological and microecological background, the applicable drugs, and the necessary microbiological surveillance for Selective Decontamination of the Digestive tract (SDD), the results of 2 new metaanalyses of 22 and 25 individual randomized studies are discussed. A 50%-reduction of the pneumonia incidence results in an only marginal reduction of the mortality rate in the subgroup of topically plus for the first few days systemically treated patients in mixed intensive care units. Facing the weak prognostic relevance of ventilator pneumonia, the reduction of microbial translocation from the lower GI tract as a major goal for SDD is discussed. The chance and the need to confirm a mortality benefit in multicentre trials enrolling large numbers of homogeneous surgical patients are explained. At the present time, SDD as a routine can not (yet) be recommended.
在概述了消化道选择性去污（SDD）的流行病学和微生态背景、适用药物以及必要的微生物监测之后，讨论了两项分别包含22项和25项个体随机研究的新荟萃分析结果。在混合重症监护病房中，接受局部加最初几天全身治疗的患者亚组中，肺炎发病率降低50%仅使死亡率略有降低。鉴于呼吸机相关性肺炎的预后相关性较弱，讨论了将减少下消化道微生物易位作为SDD的主要目标。解释了在纳入大量同质外科患者的多中心试验中确认死亡率获益的可能性和必要性。目前，尚不能（仍不能）推荐将SDD作为常规治疗方法。
