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

Content Provider	Springer Nature : BioMed Central
Author	Shibli, Adeel B Milbrandt, Eric B Baldisseri, Marie
Abstract	Citation de 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]. Background Selective 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. Methods Objective: To evaluate the effectiveness of SDD and SOD in intensive care unit (ICU) patients. Design A controlled, crossover study using cluster randomization. Setting 13 ICUs in the Netherlands between May 2004 and July 2006. Subjects 5939 patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. Intervention In 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. Outcomes Mortality at day 28 was the primary end point. Monthly point-prevalence studies were performed to analyze antibiotic resistance. Results A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. Conclusions In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc9048.pdf
Ending Page	3
Page Count	3
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc9048
Journal	Critical Care
Issue Number	3
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2010-06-18
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine
Content Type	Text
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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

Analysis of the mortality rate in patients admitted to the ICU for severe community-acquired pneumonia

Selective decontamination of the digestive tract reduces mortality in critically ill patients

Epidemiology of ventilator-associated pneumonia in ICU patients

Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance

Nosocomial pneumonia in ICU patients after surgical and percutaneous tracheostomy

Risk factors and mortality associated with acute respiratory failure in the ICU

Role of chlorhexidine gluconate in ventilator-associated pneumonia prevention strategies in ICU patients: where are we headed?

Prevention of ventilator-associated pneumonia in the surgical ICU at Siriraj Hospital

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

Similar Documents

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

Analysis of the mortality rate in patients admitted to the ICU for severe community-acquired pneumonia

Selective decontamination of the digestive tract reduces mortality in critically ill patients

Epidemiology of ventilator-associated pneumonia in ICU patients

Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance

Nosocomial pneumonia in ICU patients after surgical and percutaneous tracheostomy

Risk factors and mortality associated with acute respiratory failure in the ICU

Role of chlorhexidine gluconate in ventilator-associated pneumonia prevention strategies in ICU patients: where are we headed?

Prevention of ventilator-associated pneumonia in the surgical ICU at Siriraj Hospital

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