Ruza F, Alvarado F, Herruzo R, Delgado M A, García S, Dorao P, Goded F
Servicio de Cuidados Intensivos Pediátricos Hospital Infantíl La Paz, Madrid, Spain.
Eur J Epidemiol. 1998 Oct;14(7):719-27. doi: 10.1023/a:1007487330893.
To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients.
A prospective, randomized, non-blinded and controlled clinical microbiology study.
The pediatric intensive care unit (PICU) of a tertiary level pediatric university hospital. CRITERIA FOR INCLUSION: Patients 1 month to 14 years old, who underwent some kind of manipulation or instrumentation (mechanical ventilation, vascular cannulation, monitoring of intracranial pressure, thoracic or abdominal drainage, bladder catheterization, peritoneal dialysis, etc.) and/or presented a neurological coma requiring a stay in the PICU of 3 or more days.
Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation. The treatment group comprised 116 patients and the control group, 110 patients.
The treatment group received a triple therapy of colimycin, tobramycin and nystatin administered orally or via nasogastric tube every 6 hours. All patients with mechanical ventilation or immune-depression received decontamination treatment of the oropharyngeal cavity with hexitidine (Oraldine 0.5 mg/ml) every 6-8 hours in accordance with the PICU's conventional protocol.
Up to 10 types of nosocomial infection were diagnosed following criteria of the Centers for Disease Control (CDC). The severity and manipulation of the patients on admission was assessed using the therapeutic intervention scoring system (TISS) and multi-organ system failure scores (MOSF).
UNIVARIANT ANALYSIS: SDD did not significantly reduce the incidence of NI, antibiotic use, the length of stay, or mortality; although a small percentage of respiratory and urinary tract infections was detected, catheter-related bacteremia was the most common infection. MULTIVARIANT ANALYSIS: Controlling the risk factors for each child through log regression showed that SDD acted as a protective factor for more than 90% of the sample with respect to the appearance of respiratory and urinary tract infections, reducing the risk of such infections to 1/5 and 1/3, respectively.
SDD was effective in controlling respiratory and urinary tract infections in children admitted to the PICU, but it did not reduce the incidence of other types of nosocomial infection.
评估选择性消化道去污（SDD）对控制重症儿科患者医院感染（NI）的有效性。
一项前瞻性、随机、非盲法对照临床微生物学研究。
一家三级儿科大学医院的儿科重症监护病房（PICU）。纳入标准：年龄在1个月至14岁之间，接受过某种操作或器械治疗（机械通气、血管插管、颅内压监测、胸腹腔引流、膀胱插管、腹膜透析等）和/或出现需要在PICU住院3天或更长时间的神经昏迷的患者。
在2年的时间里，244名患者符合纳入标准；18名患者因违反方案被撤出。治疗组包括116名患者，对照组包括110名患者。
治疗组每6小时口服或通过鼻胃管接受黏菌素、妥布霉素和制霉菌素的三联疗法。所有接受机械通气或免疫抑制的患者按照PICU的常规方案每6 - 8小时用己西定（0.5 mg/ml奥地碘）进行口咽腔去污治疗。
按照疾病控制中心（CDC）的标准诊断多达10种医院感染类型。入院时使用治疗干预评分系统（TISS）和多器官系统衰竭评分（MOSF）评估患者的严重程度和操作情况。
单变量分析：SDD并未显著降低NI的发生率、抗生素使用量、住院时间或死亡率；尽管检测到一小部分呼吸道和尿路感染，但导管相关菌血症是最常见的感染。多变量分析：通过对数回归控制每个儿童的危险因素显示，对于90%以上的样本，SDD对呼吸道和尿路感染的发生起到保护作用，将此类感染的风险分别降低至1/5和1/3。
SDD对控制入住PICU儿童的呼吸道和尿路感染有效，但并未降低其他类型医院感染的发生率。
