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Titolo:
Prevention of ventilator-associated pneumonia by oral decontamination - A prospective, randomized, double-blind, placebo-controlled study
Autore:
Bergmans, DCJJ; Bonten, MJM; Gaillard, CA; Paling, JC; van der Geest, S; van Tiel, FH; Beysens, AJ; de Leeuw, PW; Stobberingh, EE;
Indirizzi:
Univ Utrecht Hosp, Dept Internal Med, Div Infect Dis & AIDS, NL-3584 CX Utrecht, Netherlands Univ Utrecht Hosp Utrecht Netherlands NL-3584 CX CX Utrecht, Netherlands Univ Groningen Hosp, Dept Surg, Groningen, Netherlands Univ Groningen Hosp Groningen Netherlands Surg, Groningen, Netherlands Eemland Hosp, Dept Internal Med, Amersfoort, Netherlands Eemland Hosp Amersfoort Netherlands ternal Med, Amersfoort, Netherlands Univ Hosp Maastricht, Dept Internal Med, Maastricht, Netherlands Univ HospMaastricht Maastricht Netherlands ed, Maastricht, Netherlands Univ Hosp Maastricht, Dept Med Microbiol, Maastricht, Netherlands Univ Hosp Maastricht Maastricht Netherlands ol, Maastricht, Netherlands Univ Hosp Maastricht, Dept Clin Pharm, Maastricht, Netherlands Univ Hosp Maastricht Maastricht Netherlands rm, Maastricht, Netherlands
Titolo Testata:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
fascicolo: 3, volume: 164, anno: 2001,
pagine: 382 - 388
SICI:
1073-449X(20010801)164:3<382:POVPBO>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTENSIVE-CARE-UNIT; RESPIRATORY-TRACT INFECTIONS; GRAM-NEGATIVE BACILLI; NOSOCOMIAL PNEUMONIA; DIGESTIVE-TRACT; SELECTIVE DECONTAMINATION; MECHANICAL VENTILATION; ENTEROCOCCUS-FAECALIS; TRACHEAL COLONIZATION; GASTRIC COLONIZATION;
Keywords:
cross infection, prevention and control; respiration, artificial, adverse effects; antibiotics, administration and dosage infection; control methods; pneumonia, etiology, prevention and control; intubation, intratracheal, adverse effects;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Bonten, MJM Univ Utrecht Hosp, Dept Internal Med, Div Infect Dis & AIDS, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands Univ Utrecht Hosp Heidelberglaan 100 Utrecht Netherlands NL-3584 CX
Citazione:
D.C.J.J. Bergmans et al., "Prevention of ventilator-associated pneumonia by oral decontamination - A prospective, randomized, double-blind, placebo-controlled study", AM J R CRIT, 164(3), 2001, pp. 382-388

Abstract

Colonization of the intestinal tract has been assumed to be important in the pathogenesis of ventilator-associated pneumonia (VAP), but relative Impacts of oropharyngeal, gastric, or intestinal colonization have not been elucidated. Our aim was to prevent VAP by modulation of oropharyngeal colonization, without influencing gastric and Intestinal colonization and without systemic prophylaxis. In a prospective, randomized, placebo-controlled, double-blind study, 87 patients received topical antimicrobial prophylaxis (gentamicin/ colistin/vancomycin 2% in Orabase, every 6 h) in the oropharynx and 139 patients, divided over two control groups, received placebo (78 patients were studied in the presence of patients receiving topical prophylaxis [control group A] and 61 patients were studied In an intensive care unit where no topical prophylaxis was used [control group B]). Baseline characteristics were comparable in all three groups. Topical prophylaxis eradicated colonization present on admission in oropharynx (75% in study group versus 0% in control group A [p < 0.00001] and 9% in control group B patients [p < 0.00001]) and In trachea (52% versus 22% in A [p = 0.03] and 7% in 8 [p = 0.004]). Moreover, topical prophylaxis prevented acquired oropharyngeal colonization (10% versus 59% in A [p < 0.00001] and 63% in B [p < 0.00001]). Colonization rates In stomach and intestine were not affected. Incidences of VAP were 10% in study patients, 31% in Group A, and 23% in Group B patients(p = 0.001 and p = 0.04 respectively). This was not associated with shorter durations of ventilation or ICU stay or better survival. Oropharyngeal colonization is of paramount importance in the pathogenesis of VAP, and a targeted approach to prevent colonization at this site is a very effective method of infection prevention.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/10/20 alle ore 04:00:29