Influence of Combined Intravenous and Topical Antibiotic Prophylaxis on the Incidence of Infections, Organ Dysfunctions, and Mortality in Critically Ill Surgical Patients

Krueger, Wolfgang A.; Lenhart, F.-P.; Neeser, G.; Ruckdeschel, G.; Schreckhase, Heidi; Eissner, Hans-Joachim; Forst, H.; Eckart, J.; Peter, K.; Unertl, K.

doi:10.1164/rccm.2105141

Cited by 271 publications

(141 citation statements)

References 60 publications

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“…While often recommended, it appears not to be routinely practiced. Two recent studies will further the debate, as they demonstrated significant reductions in VAP and mortality with selective decontamination of the digestive tract (47,114). These two studies were performed under conditions where selective decontamination of the digestive tract is most effective, i.e., surgical intensive care units housing patients less likely to be colonized with resistant bacteria.…”

Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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“…1,2 Although there is still controversy regarding the universal indication of SID for critical care patients, in 5 of 9 published meta-analyses and in 4 recent randomized studies not included in a previous meta-analysis, a reduction in the mortality related to SID administration could be demonstrated in patients admitted to intensive care units (ICUs), mostly when systemic antibiotics were administered. [1][2][3][4][5][6] Bacterial infections (especially those involving gram-negative bacteria) are major complications for liver transplant recipients (LTRs); their frequency ranges from 20% to 80%. They contribute substantially to longer hospital stays and increased hospital costs 7 and are the leading cause of death in this population.…”

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confidence: 99%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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The role of selective intestinal decontamination with fluoroquinolones (FQ-SID) in the prevention of early bacterial infections (EBIs) in liver transplant recipients (LTRs) is unknown. We used the online database of the Spanish Network of Infection in Transplantation/ Spanish Network for Research in Infectious Diseases, which prospectively analyzed 1010 LTRs from 12 Spanish hospitals from September 2003 to February 2005. We compared the incidence and etiology of EBIs (30 days after transplantation) in 415 LTRs from 4 centers that used FQ-SID (>7 days) and in 595 LTRs from 8 hospitals that did not use FQ-SID. A multivariate logistic regression analysis (including an adjustment for the transplant center factor) was performed to evaluate the potential protective factor of FQ-SID in the development of EBIs. We reported 266 EBI episodes in 252 LTRs (incidence ¼ 24.9%). There were no differences in the incidence of EBIs between patients in the FQ-SID group and patients not in the FQ-SID group [109/415 (26.3%) versus 143/595 (24%), P ¼ 0.9]. Although LTRs who received FQ-SID had a lower incidence of infections due to enteric bacteria (2.7% versus 6.5%, P ¼ 0.007) and a higher incidence of infections due to nonfermenting gram-negative bacilli (6.6% versus 2.6%, P ¼ 0.004), these findings could not be confirmed after an adjustment by the center factor in the multivariate models. We found no significant differences in the incidence of enterococcal infections (3.4% with FQ-SID versus 3.9% without FQ-SID, P ¼ 0.5). Multivariate analysis did not confirm any protective effect of FQ-SID against the development of EBIs by enteric bacteria. In conclusion, FQ-SID does not reduce the incidence of EBIs in LTRs and could be withheld from this group of patients. Liver Transpl 17:896-904,

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“…Despite their excellent efficacy, broad antibacterial spectrum and good tolerability, cephalosporins, which rapidly induce drug-resistant bacteria, are arguably not the ideal drugs for preventive therapy [70,71]. Previous studies on prophylactic antibiotic treatment in other settings did not support the assumption that short-term prophylactic antibiotic drug treatments facilitate the development of antibiotic drug resistance [38,72]. However, if antibiotic prophylaxis should be implemented into the daily routine of stroke units, and large numbers of patients would be treated with the same antibiotic drugs within a single ward, the development of drug resistance could constitute a point of concern.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

Schwarz

2016

Neurotherapeutics

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Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the BPreventive Antibiotics in Stroke Study^, antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.

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Influence of Combined Intravenous and Topical Antibiotic Prophylaxis on the Incidence of Infections, Organ Dysfunctions, and Mortality in Critically Ill Surgical Patients

Cited by 271 publications

References 60 publications

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

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