一个随机临床试验:呼吸患者的消毒策略和抗生素耐药微生物的血液感染
Bastiaan H Wittekamp1, Nienke L Plantinga2, Ben S Cooper3
1Intensive Care Center and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
JAMA
|October 23, 2018
概括
赫西丁 (CHX) 口水,选择性口腔消毒 (SOD) 和选择性消化道消毒 (SDD) 并没有减少高耐药性ICU中的多耐药性グラム阴性细菌 (MDRGNB) 在ICU获得的血液感染. 与标准治疗相比,死亡率也没有显著差异.
科学领域:
- 传染性疾病
- 危急护理医学
- 抗菌药物耐药性
背景情况:
- 具有高抗生素耐药性的重症监护室 (ICU) 面临预防多抗药性阴性细菌 (MDRGNB) 感染的挑战.
- 赫西丁 (CHX) 口水,选择性口腔消毒 (SOD) 和选择性消化道消毒 (SDD) 在减少这些感染和死亡率方面的有效性尚未得到充分证实.
研究的目的:
- 调查CHX,SOD和SDD干预措施与ICU获得的MDRGNB血液感染的发生率之间的联系.
- 评估这些干预措施对中度至高抗生素耐药性的ICU中28天死亡率的影响.
主要方法:
- 一项涉及13个欧洲重症监护室的随机试验,该试验的基线患有扩展谱β- 乳糖酶产生的肠杆菌.
- 包括需要机械呼吸超过24小时的患者. 干预措施 (CHX口水,SOD,SDD) 与标准护理 (CHX身体洗和手部卫生) 的基线期进行了比较.
主要成果:
- 与标准治疗相比,CHX,SOD或SDD没有显著减少ICU获得的MDRGNB血流感染. 发病率为2. 1% (基线),1. 8% (CHX),1. 5% (SOD) 和1. 2% (SDD).
- 对MDRGNB感染的绝对风险降低为CHX的0. 3%,SOD的0. 6%和SDD的0. 8%,重叠的置信区间表明没有统计意义.
- 在所有时期,28天死亡率均相似: 31. 9% (基线),32. 9% (CHX),32. 4% (SOD) 和34. 1% (SDD),没有发现显著差异.
结论:
- 在中度至高抗生素耐药性的ICU中,CHX口水,SOD和SDD似乎没有降低ICU获得的MDRGNB血流感染的发生率.
- 这些干预措施与在研究中的ICU中机械呼吸患者的28天死亡率显著下降无关.
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