Oropharyngeal decontamination in intensive care patients less is not more 英文参考文献.docVIP

Available online /content/13/5/183 Commentary Oropharyngeal decontamination in intensive care patients: less is not more Lennie PG Derde1 and Marc JM Bonten1,2 1Julius Center for Health Sciences and Primary Care, Heidelberglaan 100, Location Stratenum, 3584 CX Utrecht, The Netherlands 2Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands Corresponding author: Lennie Derde, lderde@umcutrecht.nl See related research by Scannapieco et al., /content/13/4/R117 Published: 3 September 2009 Critical Care 2009, 13:183 (doi:10.1186/cc8013) This article is online at /content/13/5/183 ? 2009 BioMed Central Ltd Abstract oropharyngeal decontamination with antibiotics (AB-SOD)) or with topically applied chlorhexidine gluconate (CHX-SOD). Ventilator-associated pneumonia (VAP) is a common cause of morbidity, antibiotic use, increased length of stay and, possibly, increased mortality in ICU patients. Colonization of the oropharyn- geal cavity with potentially pathogenic micro-organisms is instru- mental in the pathogenesis of VAP, and selective oropharyngeal decontamination (SOD) with antibiotics (AB-SOD) or antiseptics, such as chlorhexidine gluconate (CHX-SOD), has been associated with reduced incidences of VAP. In a recent issue of Critical Care Scannapieco and colleagues investigated differences in oro- pharyngeal colonization between mechanically ventilated patients receiving oropharyngeal decontamination with 0.12% CHX-SOD either once or twice daily compared to placebo. CHX-SOD was associated with a reduction in Staphylococcus aureus coloniza- tion, but the study was underpowered to demonstrate a reduction in VAP incidence. We urgently need well-designed and adequately powered studies to evaluate the potential benefits of CHX-SOD on patient outcome in ICUs. AB-SOD was associated with reduced incidences of VAP in various studies [4-6], and