presence of tobramycin in blood and urine during selective decontamination of the digestive tract in critically ill patients, a prospective cohort study妥布霉素的存在在血液和尿液的选择性净化消化道在危重患者中,前瞻性队列研究.pdfVIP

Oudemans-van Straaten et al. Critical Care 2011, 15:R240 /content/15/5/R240 RESEARCH Open Access Presence of tobramycin in blood and urine during selective decontamination of the digestive tract in critically ill patients, a prospective cohort study 1* 1 1 2 Heleen M Oudemans-van Straaten , Henrik Endeman , Robert J Bosman , Milly E Attema-de Jonge , Marc L van Ogtrop3, Durk F Zandstra1 and Eric JF Franssen2 Abstract Introduction: Tobramycin is one of the components used for selective decontamination of the digestive tract (SDD), applied to prevent colonization and subsequent infections in critically ill patients. Tobramycin is administered in the oropharynx and gastrointestinal tract and is normally not absorbed. However, critical illness may convey gut barrier failure. The aim of the study was to assess the prevalence and amount of tobramycin leakage from the gut into the blood, to quantify tobramycin excretion in urine, and to determine the association of tobramycin leakage with markers of circulation, kidney function and other organ failure. Methods: This was a prospective observational cohort study. The setting was the 20-bed closed format-mixed ICU of a teaching hospital. The study population was critically ill patients with an expected stay of more than two days, receiving SDD with tobramycin, polymyxin-E and amphotericin-B four times daily in the oropharynx and stomach. Tobramycin concentration was measured in serum (sensitive high performance liquid chromatography - mass spectrometry/mass spectrometry (HLPC-MS/MS) assay) and 24-hour urine (conventional immunoassay), in 34 patients, 24 hours after ICU admission, and in 71 patients, once daily for 7 days. Tobramycin leakage was