Selective decontamination of the digestive tract reduces mortality in critically ill patients 英文参考文献.docVIP

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Selective decontamination of the digestive tract reduces mortality in critically ill patients 英文参考文献.doc

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Selective decontamination of the digestive tract reduces mortality in critically ill patients 英文参考文献

Available online /content/7/2/107 Commentary Selective decontamination of the digestive tract reduces mortality in critically ill patients Marcus J Schultz1, Evert de Jonge1 and Jozef Kesecioglu2 1Internist-Intensivist, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, The Netherlands 2Anaesthesiologist-Intensivist, Division of Perioperative Care, Cardiopulmonary Intensive Care and Neuro Intensive Care, University Medical Center, Utrecht, The Netherlands Correspondence: Marc J Schultz, m.j.schultz@amc.uva.nl Published online: 24 January 2003 Critical Care 2003, 7:107-110 (DOI 10.1186/cc1873) This article is online at /content/7/2/107 ? 2003 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Several emotional responses may be invoked in critical care physicians when confronted with selective decontamination of the digestive tract (SDD). Although recent meta-analyses have shown that the use of SDD reduces the occurrence of ventilator-associated pneumonia and improves ICU survival, the effectiveness of SDD has remained controversial. We recently concluded a large randomized, controlled trial on the use of SDD that showed improved survival of ICU patients treated with SDD. A second concern regarding use of SDD has been the fear for the emergence of antimicrobial resistance. Interestingly, a recently published study did not confirm this fear, and our recently finished study even demonstrated a decline in colonization with P. aeruginosa and enterobacteriaceae that were resistant against tobramycin, ceftazidime, imipenem and ciprofloxacin. The hopes are that this study will at long last end the debate about the efficacy and safety of SDD in critically ill patients. Keywords bacterial resistance, intensive care unit acquired infections, pneumonia, selective decontamination of the digestive tract, ventilator-associated pneumonia Recent meta-analyses have shown