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Dirty mouth? Should you clean it out? Decontamination for the prevention of pneumonia and mortality in the ICU

机译：脏口？你应该清理吗？去ICU预防肺炎和死亡率的去污

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Citationde Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, Bernards AT, Kuijper EJ, Joore JC, Leverstein-van Hall MA, Bindels AJ, Jansz AR, Wesselink RM, de Jongh BM, Dennesen PJ, van Asselt GJ, te Velde LF, Frenay IH, Kaasjager K, Bosch FH, van Iterson M, Thijsen SF, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LP, Sturm PD, Harinck HI, Voss A, Uijtendaal EV, Blok HE, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJ: Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009, 360:20-31 [1].BackgroundSelective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting.MethodsObjective: To evaluate the effectiveness of SDD and SOD in intensive care unit (ICU) patients.DesignA controlled, crossover study using cluster randomization.Setting13 ICUs in the Netherlands between May 2004 and July 2006.Subjects5939 patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible.InterventionIn each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics.OutcomesMortality at day 28 was the primary end point. Monthly point-prevalence studies were performed to analyze antibiotic resistance.
机译：Citationde Smet AM，Kluytmans JA，Cooper BS，Mascini EM，Benus RF，van der Werf TS，van der Hoeven JG，Pickkers P，Bogaers-Hofman D，van der Meer NJ，Bernards AT，Kuijper EJ，Joore JC，Leverstein- van Hall MA，Bindels AJ，Jansz AR，Wesselink RM，de Jongh BM，Dennesen PJ，van Asselt GJ，te Velde LF，Frenay IH，Kaasjager K，Bosch FH，van Iterson M，Thijsen SF，Kluge GH，Pauw W， de Vries JW，Kaan JA，Arends JP，Aarts LP，Sturm PD，Harinck HI，Voss A，Uijtendaal EV，Blok HE，Thieme Groen ES，Pouw ME，Kalkman CJ，Bonten MJ：ICU中消化道和口咽的净化耐心。 N Engl J Med 2009，360：20-31 [1]。方法目的：评估SDD和SOD在重症监护病房（ICU）患者中的有效性.DesignA对照，采用整群随机分组的交叉研究.2004年5月至2006年7月在荷兰设置13个ICU。受试者5939名预期持续时间的患者插管时间超过48小时或预期ICU停留时间超过72小时的患者符合条件。 SDD包括4天静脉注射头孢噻肟和在口咽和胃中局部应用妥布霉素，粘菌素和两性霉素B。 SOD仅由相同抗生素的口咽应用组成，结果终点是第28天的死亡率。每月进行点流行度研究以分析抗生素耐药性。

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