消化道选择性去污：重症监护病房停止常规应用的效果

Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU.

作者信息

Tissot van Patot H A, Leusink J A, Roodenburg J, de Jongh B M, Lau H S, de Boer S, de Boer A

机构信息

Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, Utrecht, The Netherlands.

出版信息

Pharm World Sci. 1996 Oct;18(5):171-7. doi: 10.1007/BF00820728.

DOI:10.1007/BF00820728

PMID:8933577

Abstract

BACKGROUND

Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.

OBJECTIVE

To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.

DESIGN

Retro- and prospective follow-up.

PATIENTS

Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.

RESULTS

There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).

CONCLUSION

The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.

摘要

背景

在欧洲的重症监护病房（ICU）中，广泛使用不可吸收抗生素进行消化道选择性去污（SDD）以预防重症患者的医院感染。最近的三项荟萃分析表明，SDD对这些患者的住院时间和死亡率没有影响，此后几家ICU决定停止常规使用SDD。

目的

研究在一家ICU中，停止使用SDD对术后患者医院感染、死亡率和住院时间的影响。

设计

回顾性和前瞻性随访。

患者

纳入在ICU接受机械通气（MV）≥5天的术后患者。回顾性组（SDD组）包括138例患者（平均年龄66岁，范围10 - 91岁；78%为男性），前瞻性组（非SDD组）包括142例患者（平均年龄67岁，范围18 - 85岁；65%为男性）。SDD方案包括多粘菌素、妥布霉素和两性霉素B。停止使用SDD的同时缩短了常规静脉注射头孢呋辛的预防时间。

结果

与SDD组相比，非SDD组的ICU平均住院时间从21天非显著性增加至23天（p>0.05）。280例患者中有97例（35%）在ICU死亡。非SDD组的死亡风险较低（调整后的风险比为0.7，95%置信区间为0.5 - 1.1）。非SDD组中因感染导致死亡的比例有增加趋势（停止使用SDD的患者中为38%，而SDD组中为20%）（p>0.05）。非SDD组呼吸道感染的发生率（每1000人日）为80（95%置信区间48 - 113），而SDD组为19（95%置信区间8 - 22）（调整后的风险比为4.5（95%置信区间2.9 - 7.1））。