Antibiotska profilaksa za smanjenje infekcija respiratornog trakta i mortaliteta u odraslih liječenih u intenzivnoj njezi
Abstract
Background
Pneumonia is an important cause of mortality in intensive care units (ICUs). The incidence of pneumonia in ICU patients ranges between 7% and 40%, and the crude mortality from ventilator‐associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to pneumonia, it has been shown to contribute to mortality in ICUs independently of other factors that are also strongly associated with such deaths.
Objectives
To assess the effects of prophylactic antibiotic regimens, such as selective decontamination of the digestive tract (SDD) for the prevention of respiratory tract infections (RTIs) and overall mortality in adults receiving intensive care.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register; MEDLINE (January 1966 to March 2009); and EMBASE (January 1990 to March 2009).
Selection criteria
Randomised controlled trials (RCTs) of antibiotic prophylaxis for RTIs and deaths among adult ICU patients.
Data collection and analysis
At least two review authors independently extracted data and assessed trial quality.
Main results
We included 36 trials involving 6914 people. There was variation in the antibiotics used, patient characteristics and risk of RTIs and mortality in the control groups. In trials comparing a combination of topical and systemic antibiotics, there was a significant reduction in both RTIs (number of studies = 16, odds ratio (OR) 0.28, 95% confidence interval (CI) 0.20 to 0.38) and total mortality (number of studies = 17, OR 0.75, 95% CI 0.65 to 0.87) in the treated group. In trials comparing topical antimicrobials alone (or comparing topical plus systemic versus systemic alone) there was a significant reduction in RTIs (number of studies = 17, OR 0.44, 95% CI 0.31 to 0.63) but not in total mortality (number of studies = 19, OR 0.97, 95% CI 0.82 to 1.16) in the treated group.
Authors' conclusions
A combination of topical and systemic prophylactic antibiotics reduces RTIs and overall mortality in adult patients receiving intensive care. Treatment based on the use of topical prophylaxis alone reduces respiratory infections but not mortality. The risk of resistance occurring as a negative consequence of antibiotic use was appropriately explored only in one trial which did not show any such effect.
PICO
Plain language summary
Antibiotici za smanjenje smrtnosti i infekcija dišnog sustava u osoba liječenih u intenzivnoj njezi u bolnici
Infekcije stečene u jedinicama intenzivnog liječenja (JIL‐u) važne su komplikacije u liječenju bolesnika s vrlo teškim bolestima kojima treba ventiliranje (mehaničku potporu disanja). Neki ljudi će umrijeti zbog tih infekcija. Znatni napori ulažu se u ispitivanje postupaka koji bi mogli smanjiti taj problem; jedan od tih uključuje upotrebu antibiotika kao preventivnu intervenciju, što se obično naziva selektivna dekontaminacija probavnog trakta. Ovaj Cochrane sustavni pregled uključuje 36 ispitivanja s ukupno 6914 bolesnika liječenih u JIL‐u i istražuje da li primjena antibiotika sprječava razvoj infekcija. Antibiotici su davani na dva različita načina. U nekim ispitivanjima se primjenuju antibiotici putem nazogastrične sonde (lokalno) i intravenski (sistemski). U drugim ispitivanjima su primjenjivani samo lokalno. Rezultati sustavnog pregleda pokazuju da kada bolesnici primaju kombinaciju lokalnih plus sistemskih antibiotika postoji manje infekcija i smrti. Kada pacijenti primaju samo lokalnu terapiju, zabilježeno je manje infekcija, ali se broj umrlih nije promijenio. Iako se čini da je ta terapija djelotvorna, ne koristi se često u kliničkoj praksi zbog bojazni o mogućem razvoju rezistencije na antibiotike (stanje kada bakterije ne reagiraju na lijekove).
