重要性:
消化道(SDD)和选择性口咽去污(SOD)的选择性是去污在重症监护病房(ICU)中使用,并具有改善的患者预后相关预防性抗生素治疗方案。存在争议关于对患者的预后及耐药性这两项措施的相对影响。
目的:
为了比较SDD和SOD的影响,应用为单位宽的干预,对抗生素抗性和患者结果。
设计,地点和对象:
务实,整群随机交叉试验比较12个月SOD的在12个月SDD的16个ICU荷兰2009年8月1日和2月1日之间,2013年患者入住ICU的预计长度超过48小时有资格获得的方案,以及5881本6116例患者纳入分别SOD和SDD,临床结果分析。
干预:
重症监护病房,随机给予一种SDD或SOD。
主要成果和指标:
抗生素抗性的革兰氏阴性菌的单元范围的流行。次要结果为天-28死亡率,ICU获得菌血症和ICU停留长度。
结果:
在点患病调查,肛周拭子抗生素抗性革兰氏阴性菌的患病率分别为显著SDD期间降低与SOD相比;for aminoglycoside resistance, average prevalence was 5.6% (95% CI, 4.6%-6.7%) during SDD and 11.8% (95% CI, 10.3%-13.2%) during SOD (P < .001). During both interventions the prevalence of rectal carriage of aminoglycoside-resistant gram-negative bacteria increased 7% per month (95% CI, 1%-13%) during SDD (P = .02) and 4% per month (95% CI, 0%-8%) during SOD (P = .046; P = .40 for difference). Day 28-mortality was 25.4% and 24.1% during SOD and SDD, respectively (adjusted odds ratio, 0.96 [95% CI, 0.88-1.06]; P = .42), and there were no statistically significant differences in other outcome parameters or between surgical and nonsurgical patients. Intensive care unit-acquired bacteremia occurred in 5.9% and 4.6% of the patients during SOD and SDD, respectively (odds ratio, 0.77 [95% CI, 0.65-0.91]; P = .002; number needed to treat, 77).
结论和相关性:
SDD和SOD的单元范围内的应用,用抗生素抗性水平低和在每天28死亡率没有差异相关联。与SOD相比,SDD用抗生素抗性革兰氏阴性菌的直肠支架下部和ICU获得菌血症但在耐氨基糖苷类革兰氏阴性细菌具有更明显的逐渐增加相关联。
试验注册:
trialregister.nlIdentifier:NTR1780。