RESUMEN
Surveillance cultures are essential in the management of infection in the intensive care unit. They are crucial in the assessment of the efficacy of selective digestive decontamination.
Asunto(s)
Cuidados Críticos/métodos , Descontaminación/métodos , Monitoreo del Ambiente , Tracto Gastrointestinal/microbiología , Enfermedad Crítica , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Humanos , Control de Infecciones , Unidades de Cuidados IntensivosRESUMEN
We carried out a systematic review and meta-analysis of randomized trials to explore the effectiveness of oral chlorhexidine on nosocomial pneumonia, causative bacteria, and mortality. PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for randomized trials in critically ill patients receiving oral chlorhexidine. Odds ratios (OR) were pooled with the random effects model. Twenty-two randomized trials including 4277 patients were identified. Chlorhexidine significantly reduced the incidence of nosocomial pneumonia (OR 0.66; 95% confidence interval [CI] 0.51-0.85) and ventilator-associated pneumonia (OR 0.68, 95% CI 0.53-0.87). There was a significant reduction of nosocomial pneumonia due to both Gram-positive (OR 0.41; 95% CI 0.19-0.85) and Gram-negative (OR 0.68; 95% CI 0.51-0.90) bacteria, but only pneumonia due to "normal" flora (OR 0.51; 95% CI 0.33-0.80). The subgroup analysis revealed a significant benefit of chlorhexidine on nosocomial pneumonia in surgical patients only (OR 0.52; 95% CI 0.33-0.82). Mortality was not affected. This review indicates that in critically ill, mainly surgical, patients, oral chlorhexidine reduces nosocomial pneumonia, ventilator-associated pneumonia, nosocomial pneumonia due to Gram-positive and Gram-negative bacteria, and due to "normal" flora, without affecting mortality. Further studies should explore the efficacy of oral chlorhexidine in non-surgical critically ill population.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Clorhexidina/uso terapéutico , Infección Hospitalaria/prevención & control , Antisépticos Bucales/uso terapéutico , Neumonía/prevención & control , Administración Oral , Antiinfecciosos Locales/administración & dosificación , Clorhexidina/administración & dosificación , Enfermedad Crítica/mortalidad , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Humanos , Higiene Bucal , Neumonía/microbiología , Neumonía/mortalidadRESUMEN
Selective decontamination of the digestive tract has been proven to prevent severe infections and to reduce mortality in critically ill patients. Historical arguments against its use, like the development of bacterial resistance and the absence of influence on mortality, have not been confirmed. Recent clinical trials designed to evaluate these variables and meta-analyses showed remarkable reductions in the incidence of resistant bacteria and a significant beneficial effect on survival. This review will update the evidence on the efficacy of selective decontamination of the digestive tract, and the issue of emergence of resistance, using data from randomized controlled trials and meta-analyses.
RESUMEN
Selective decontamination of the digestive tract (SDD) evolved into evidence-based medicine as a tool to prevent infections in critically ill patients. It significantly reduces mortality, pneumonia, bloodstream infections and the onset of resistance if the full four-component regimen is used. The use of only oral decontamination may reduce the incidence of pneumonia, but it has no significant impact on mortality. Moreover, the full SDD protocol significantly reduces the fecal carriage of multiresistant aerobic Gram-negative bacteria, whereas oral decontamination only is associated with increased carriage of multiresistant aerobic Gram-negative bacilli.
