Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T04:17:41.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Inapparent Outbreaks of Ventilator-Associated Pneumonia An Ecologic Analysis of Prevention and Cohort Studies

Published online by Cambridge University Press:  21 June 2016

James C. Hurley
James C. Hurley*
Affiliation:
Infection Control Committees of St. John of God Hospital and Ballarat Health Services, Ballarat; the Internal Medicine Service, Ballarat Health Services, Ballarat; and the Rural Clinical School, University of Melbourne, Parkville, Victoria, Australia
*
Ballarat Health Services, PO Box 577, Drummond St., N, Ballarat 3353, Victoria, Australia[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare ventilator-associated pneumonia (VAP) rates and patterns of isolates across studies of antibiotic and non-antibiotic methods for preventing VAP.

Design:

With the use of 42 cohort study groups as the reference standard, the prevalence of VAP was modeled in two linear regressions: one with the control groups and the other with the intervention groups of 96 VAP prevention studies. The proportion of patients admitted with trauma and the VAP diagnostic criteria were used as ecologic correlates. Also, the patterns of pathogenic isolates were available for 117 groups.

Results:

In the first regression model, the VAP rates for the control groups of antibiotic-based prevention studies were at least 18 (CI95, 12 to 24) per 100 patients higher than those in the cohort study groups (P < .001). By contrast, comparisons of cohort study groups with all other control and intervention groups in the first and second regression models yielded differences that were less than 6 per 100 and not significant (P > .05). For control groups with VAP rates greater than 35%, the patterns of VAP isolates, such as the proportion of Staphylococcus aureus, more closely resembled those in the corresponding intervention groups than in the cohort groups.

Conclusions:

The rates of VAP in the control groups of the antibiotic prevention studies were significantly higher than expected and the patterns of pathogenic isolates were unusual. These observations suggest that inapparent outbreaks of VAP occurred in these studies. The possibility remains that antibiotic-based VAP prevention presents a major cross-infection hazard.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 4 , April 2005 , pp. 374 - 390
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Chastre, J, Fagon, J-Y. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.CrossRefGoogle ScholarPubMed
2.Collard, HR, Saint, S, Matthay, MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003;138:494–501.CrossRefGoogle ScholarPubMed
3.Cook, DJ, De Jonghe, B, Brochard, L, Brun-Buisson C. Influence of airway management on ventilation associated pneumonia: evidence from randomized trials. JAMA 1998;279:781–787.CrossRefGoogle ScholarPubMed
4.Akca, O, Koltka, K, Uzel, S, et al.Risk factors for early onset, ventilator-associated pneumonia in critical care patients. Anesthesiology 2000;93:638–645.CrossRefGoogle ScholarPubMed
5.Antonelli, M, Moro, ML, Capelli, O, et al.Risk factors for early onset pneumonia in trauma patients. Chest 1994;105:224–228.CrossRefGoogle ScholarPubMed
6.Baker, AM, Meredith, JW, Haponik, EEPneumonia in intubated trauma patients: microbiology and outcomes. Am J Respir Crit Care Med 1996;153:343–349.CrossRefGoogle ScholarPubMed
7.Bercault, N, Boulain, T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001;29:2303–2309.CrossRefGoogle Scholar
8.Bonten, MJ, Gaillard, CA, Johanson, WG Jr, et al.Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 1994;150:1332–1340.CrossRefGoogle Scholar
9.Bonten, MJ, Bergmans, DC, Ambergen, AW, et al.Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med 1996;154:1339–1346.CrossRefGoogle ScholarPubMed
10.Braun, SR, Levin, AB, Clark, KL. Role of corticosteroids in the development of pneumonia in mechanically ventilated head-trauma victims. Crit Care Med 1986;14:198–201.CrossRefGoogle ScholarPubMed
11.Cenderero, JAC, Sole-Violan, J, Benitez, AB, et al.Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 1999;116:462–470.CrossRefGoogle Scholar
12.Chevret, S, Hemmer, M, Carlet, J, Langer, M. Incidence and risk factors of pneumonia acquired in intensive care units: results of a multicenter prospective study on 996 patients. Intensive Care Medicine 1993;19:256–264.CrossRefGoogle ScholarPubMed
13.Craven, DE, Kunches, LM, Kilinsky, V, Lichtenberg, DA, Make, BJ, McCabe, WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792–796.Google ScholarPubMed
14.Craven, DE, Kunches, LM, Lichtenberg, DA, et al.Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161–1168.CrossRefGoogle ScholarPubMed
15.Djedaini, K, Billard, M, Mier, L, et al.Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia. Am J Respir Crit Care Med 1995;152:1562–1569.CrossRefGoogle Scholar
16.Ewig, S, Torres, A, el-Ebiary, M, et al.Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and associations with ventilator-associated pneumonia. Am J Respir Crit Care Med 1999;159:188–198.CrossRefGoogle ScholarPubMed
17.Fagon, JY, Chastre, J, Domart, Y, et al.Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989;139:877–884.CrossRefGoogle ScholarPubMed
18.Fowler, RA, Flavin, KE, Barr, J, Weinacker, AB, Parsonnet, J, Gould, MK. Variability in antibiotic prescribing patterns and outcomes in patients with clinically suspected ventilator-associated pneumonia. Chest 2003;123:835–844.CrossRefGoogle ScholarPubMed
19.George, DL, Falk, PS, Wundernick, RG, et al.Epidemiology of ventilator-associated pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 1998;158:1839–1847.CrossRefGoogle ScholarPubMed
20.Gruson, D, Hilbert, G, Vargas, F, et al.Rotation and restricted use of antibiotics in a medical intensive care unit: impact on the incidence of ventilator associated pneumonia caused by antibiotic resistant gram-negative bacteria. Am J Respir Crit Care Med 2000;162:837–843.CrossRefGoogle Scholar
21.Gruson, D, Hilbert, G, Vargas, F, et al.Strategy of antibiotic rotation: long-term effect on incidence and susceptibilities of gram-negative bacilli responsible for ventilator-associated pneumonia. Crit Care Med 2003;31:1908–1914.CrossRefGoogle ScholarPubMed
22.Ibrahim, EH, Ward, S, Sherman, G, Kollef, MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest 2000;117:1434–1442.CrossRefGoogle ScholarPubMed
23.Ibrahim, EH, Tracy, L, Hill, C, Fraser, VJ, Kollef, MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest 2001;120:555–561.CrossRefGoogle Scholar
24.Jimenez, P, Torres, A, Rodriguez-Roisin, R, et al.Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 1989;17:882–885.CrossRefGoogle ScholarPubMed
25.Kollef, M. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993;270:1965–1970.CrossRefGoogle ScholarPubMed
26.Kollef, MH, Silver, P, Murphy, DM, Trovillion, E. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995;108:1655–1662.CrossRefGoogle ScholarPubMed
27.Kollef, MH, Von Harz, B, Prentice, D, et al.Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997;112:765–773.CrossRefGoogle ScholarPubMed
28.Koss, WG, Khalili, TM, Lemus, JF, Chelly, MM, Margulies, DR, Shabot, MM. Nosocomial pneumonia is not prevented by protective contact isolation in the surgical intensive care unit. Am Surg 2001;67:1140–1144.CrossRefGoogle Scholar
29.Langer, M, Mosconi, P, Cigada, M, Mandelli, M, The Intensive Care Unit Group of Infection Control. Long-term respiratory support and risk of pneumonia in critically ill patients. Am Rev Respir Dis 1989:104:302–305.CrossRefGoogle Scholar
30.Luna, CM, Blanzaco, D, Niederman, MS, et al.Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early predictor of outcome. Crit Care Med 2003;31:676–682.CrossRefGoogle ScholarPubMed
31.Moine, P, Timsit, J-FLassence, AD, et al.Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study. Intensive Care Medicine 2002;28:154–163.CrossRefGoogle ScholarPubMed
32.Nielsen, SL, Roder, B, Magnussen, P, Engquist, A, Frimodt-Moller N. Nosocomial pneumonia in an intensive care unit in a Danish university hospital: incidence, mortality and etiology. Scand J Infect Dis 1992;24:65–70.CrossRefGoogle Scholar
33.Nourdine, K, Combes, P, Carton, M-J, Beuret, P, Cannamela, A, Ducreux, J-C. Does non-invasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Medicine 1999;25:567–573.CrossRefGoogle Scholar
34.Papazain, L, Bregeon, F, Thirion, X, et al.Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91–97.CrossRefGoogle Scholar
35.Relio, J, Quintna, E, Ausina, V, et al.Incidence, etiology and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991;100:439–444.CrossRefGoogle Scholar
36.Relio, J, Ausina, V, Castella, J, Net, A, Prats, G. Nosocomial respiratory tract infections in multiple trauma patients: influence of level of consciousness with implications for therapy. Chest 1992;102:525–529.CrossRefGoogle Scholar
37.Relio, J, Sonora, R, Jubert, P, Artigas, A, Rue, M, Valles, J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996;154:111–115.CrossRefGoogle Scholar
38.Relio, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.CrossRefGoogle Scholar
39.Rodriguez, JL, Gibbons, KJ, Bitzer, LG, Dechert, RE, Steinberg, SM, Flint, LM. Pneumonia: incidence, risk factors, and outcome in injured patients. J Trauma 1991;31:907–914.CrossRefGoogle ScholarPubMed
40.Salata, RA, Lederman, MM, Shlaes, DM, et al.Diagnosis of pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 1987;135:426–432.Google ScholarPubMed
41.Tejada Artigas, A, Bello Dronda, S, Chacon Valles, E, et al.Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med 2001;29:304–309.CrossRefGoogle ScholarPubMed
42.Timsit, J-F, Chevret, S, Valcke, J, et al.Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools. Am J Respir Crit Care Med 1996;154:116–123.CrossRefGoogle ScholarPubMed
43.Torres, A, Aznar, R, Gatell, JM, et al.Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.CrossRefGoogle ScholarPubMed
44.Trouillet, JL, Chastre, J, Vuagnat, A, et al.Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531–539.CrossRefGoogle ScholarPubMed
45.Cook, DJ, Walter, SD, Cook, RJ, et al.Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433–440.CrossRefGoogle ScholarPubMed
46.Ben-Menachem, T, Fogel, R, Patel, RV, et al.Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit: a randomized controlled single blind study. Ann Intern Med 1994:121:568–575.CrossRefGoogle ScholarPubMed
47.Bonten, MJ, Gaillard, CA, van der Geest, S, et al.The role of intragastric acidity and stress ulcer prophylaxis on colonization and infection in mechanically ventilated ICU patients: a stratified, randomized, double-blind study of sucralfate versus antacids. Am J Respir Crit Care Med 1995;152:1825–1834.CrossRefGoogle ScholarPubMed
48.Cook, D, Guyatt, G, Marshall, J, et al.A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 1998;338:791–797.CrossRefGoogle ScholarPubMed
49.Driks, MR, Craven, DE, Celli, BR, et al.Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med 1987;317:1376–1382.CrossRefGoogle ScholarPubMed
50.Eddleston, JM, Vohra, A, Scott, P, et al.A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate or raniti-dine-treated intensive care unit patients. Crit Care Med 1991;19:1491–1496.CrossRefGoogle ScholarPubMed
51.Fabian, TC, Boucher, BA, Croce, MA, et al.Pneumonia and stress ulceration in severely injured patients: a prospective evaluation of the effects of stress ulcer prophylaxis. Arch Surg 1993;128:185–191.CrossRefGoogle ScholarPubMed
52.Kappstein, I, Schulgen, G, Friedrich, T, et al.Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding: bacterial colonization of the stomach. Am J Med 1991;91(suppl 2a):125S–131S.CrossRefGoogle ScholarPubMed
53.Laggner, AN, Lenz, KL, Base, W, Druml, W, Schneeweiss, B, Grimm, G. Prevention of upper gastrointestinal bleeding in long term ventilated patients: sucralfate versus ranitidine. Am J Med 1989;86:81–84.CrossRefGoogle ScholarPubMed
54.Mahul, PH, Auboyer, C, Jospe, R, et al.Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Medicine 1992;18:20–25.CrossRefGoogle ScholarPubMed
55.Metz, CA, Livingston, DH, Smith, JS, Larson, GM, Wilson, TH. Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multi-center, double-blind, randomized trial. Crit Care Med 1993:21:1844–1849.CrossRefGoogle Scholar
56.O'Keefe, GE, Gentilello, LM, Maier, RV. Incidence of infectious complications associated with the use of histamine 2-receptor antagonists in critically ill trauma patients. Ann Surg 1998;227:120–125.CrossRefGoogle Scholar
57.Pickworth, KK, Falcone, RE, Hoogeboom, JE, Santanello, SA. Incidence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and rantidine. Crit Care Med 1992;20 (suppl):95S.Google Scholar
58.Prod'hom, G, Leuenberger, P, Koerfer, J, et al.Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine or sucralfate as prophylaxis for stress ulcer: a randomized controlled trial. Ann Intern Med 1994;120:652–653.CrossRefGoogle ScholarPubMed
59.Reusser, P, Gyr, K, Scheidegger, D, Buchmann, B, Buser, M, Zimmerli, W. Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis. Crit Care Med 1990;18:270–274.CrossRefGoogle ScholarPubMed
60.Ryan, P, Dawson, J, Teres, D, Celoria, G, Navab, F. Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate. Arch Surg 1993;128:1353–1357.CrossRefGoogle ScholarPubMed
61.Simms, HH, DeMaria, E, McDonald, L, Peterson, D, Robinson, A, Burchard, KW. Role of gastric colonization in the development of pneumonia in critically ill trauma patients: results of a prospective randomized trial. J Trauma 1991;31:531–536.CrossRefGoogle ScholarPubMed
62.Thomason, MH, Payseur, ES, Hakenewerth, AM, et al.Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophy-Iaxis with sucralfate, antacid, and ranitidine. J Trauma 1996;41:503–508.CrossRefGoogle ScholarPubMed
63.Tryba, M. Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med 1987;83(suppl 3b):117S–124S.CrossRefGoogle ScholarPubMed
64.Ahrens, T, Sherman, G, Stewart, J, et al.Kinetic therapy is associated with reductions in pulmonary complications among patients with acute respiratory failure. Am J Respir Crit Care Med 2001:163:754.Google Scholar
65.Beuret, P, Carton, M-J, Nourdine, K, Kaaki, M, Tramoni, G, Ducreux, J-C. Prone position as prevention of lung injury in comatose patients: a prospective, randomised, controlled study. Intensive Care Medicine 2002;28:564–569.CrossRefGoogle Scholar
66.Combes, P, Fauvage, B, Oleyer, C. Nosocomial pneumonia in mechanically ventilated patients: a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Medicine 2000;26:878–882.CrossRefGoogle ScholarPubMed
67.Davis, K Jr, Evans, SL, Campbell, RS, et al.Prolonged use of heat and moisture exchanges does not affect device efficiency or frequency rate of nosocomial pneumonia. Crit Care Med 2000;28:1412–1418.CrossRefGoogle ScholarPubMed
68.De Boisblanc, BP, Castro, M, Everret, B, Grender, J, Walker, CD, Summer, WR. Effect of air-supported, continuous postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest 1993;103:1543–1547.CrossRefGoogle ScholarPubMed
69.Deppe, SA, Kelly, JW, Thoi, LL, et al.Incidence of colonisation, nosocomial pneumonia, and mortality in critically ill patients using Trach Care closed-suction system versus an open-suction system: prospective, randomised study. Crit Care Med 1990;18:1389–1393.CrossRefGoogle Scholar
70.Drakulovic, MB, Torres, A, Bauer, TT, Nicolas, JM, Nogue, S, Ferrer, M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999;354:1851–1858.CrossRefGoogle ScholarPubMed
71.Dreyfuss, D, Djedaini, K, Weber, P, et al.Prospective study of nosocomial pneumonia and of patient and circuit colonisation during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991;143:738–743.CrossRefGoogle ScholarPubMed
72.Dreyfuss, D, Djedaini, K, Gros, I, et al.Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects of patient colonization and incidence of nosocomial pneumonia. Am J Respir Crit Care Med 1995;151:986–992.Google ScholarPubMed
73.Fink, MP, Helsmoortel, CM, Stein, KL, Lee, PC, Cohn, SM. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill patients of blunt trauma: a prospective study. Chest 1990;97:132–137.CrossRefGoogle ScholarPubMed
74.Gentilello, L, Thompson, DA, Tonnesen, AS, et al.Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 1988;16:783–786.CrossRefGoogle ScholarPubMed
75.Holzapfel, L, Chevret, S, Madinier, G, et al.Influence of long-term oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomised, clinical trial. Crit Care Med 1993;21:1132–1138.CrossRefGoogle Scholar
76.Hurni, J-M, Feihl, F, Lazor, R, Leuenberger, P, Perret, C. Safety of combined heat and moisture exchanger filters in long term mechanical ventilation. Chest 1997;111:686–691.CrossRefGoogle ScholarPubMed
77.Kirschenbaum, L, Azzi, E, Sfeir, T, Tietjen, P, Astiz, M. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care. Crit Care Med 2002;30:1983–1986.CrossRefGoogle Scholar
78.Kirton, OC, DeHaven, B, Morgan, J, Morejon, O, Civetta, J. A prospective randomized comparison of an in-line heat moisture exchange filter and heated wire humidifiers: rates of ventilator-associated early-onset (community-acquired) or late-onset (hospital-acquired) pneumonia and incidence of endotracheal tube occlusion. Chest 1997;112:1055–1059.CrossRefGoogle ScholarPubMed
79.Kollef, MH, Shapiro, SD, Fraser, VJ, et al.Mechanical ventilation with and without 7-day circuit changes: a randomized controlled trial. Ann Intern Med 1995;123:168–174.CrossRefGoogle ScholarPubMed
80.Long, MN, Wickstrom, G, Grimes, A, Benton, CF, Belcher, B, Stamm, AM. Prospective, randomised study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 1996;17:14–19.CrossRefGoogle ScholarPubMed
81.Lorente, L, Lecuona, M, Malaga, J, Revert, C, Mora, ML, Sierra, A. Bacterial filters in respiratory circuits: an unnecessary cost? Crit Care Med 2003;31:2126–2130.CrossRefGoogle ScholarPubMed
82.Maclntyre, NR, Helms, M, Wunderink, R, Schmidt, G, Sahn, SA. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care 1999;44:1447–1451.Google Scholar
83.Memish, ZA, Oni, GA, Djazmati, W, Cunningham, G, Mah, MW. A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia. Am J Infect Control 2001;29:301–305.CrossRefGoogle ScholarPubMed
84.Roustan, JP, Kienlen, J, Aubas, P, Aubas, S, du Cailar, J. Comparison of hydrophobic heat and moisture exchanges with headed humidifier during prolonged mechanical ventilation. Intensive Care Medicine 1992;18:97–100.CrossRefGoogle Scholar
85.Smulders, K, van der Hoeven, H, Weers-Pothoff, I, Vandenbroucke-Grauls, C. A randomised clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002;121:858–862.CrossRefGoogle ScholarPubMed
86.Summer, WR, Curry, P, Haponik, EF, Nelson, S, Elston, R. Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-related groups. J Crit Care 1989;4:45–53.CrossRefGoogle Scholar
87.Thomachot, L, Viviand, X, Arnaud, S, Boisson, C, Martin, CD. Comparing two heat and moisture exchangers, one hydrophobic and one hygroscopic, on humidifying efficacy and the rate of nosocomial pneumonia. Chest 1998;114:1383–1389.CrossRefGoogle ScholarPubMed
88.Traver, GA, Tyler, ML, Hudson, LD, Sherrill, DL, Quan, SF. Continuous oscillation: outcome in critically ill patients. J Crit Care 1995:10:97–103.CrossRefGoogle ScholarPubMed
89.Valles, J, Artigas, A, Relio, J, et al.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–186.CrossRefGoogle ScholarPubMed
90.Whiteman, K, Nachtmann, L, Kramer, D, Sereika, S, Bierman, M. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care 1995;4:133–139.CrossRefGoogle Scholar
91.Abele-Horn, M, Dauber, A, Bauernfeind, A, et al.Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SPO). Intensive Care Medicine 1997;23:187–195.CrossRefGoogle Scholar
92.Aerdts, SJA, van Dalen, R, Clasener, HAL, Festen, J, van Lier, HJJ, Vollaard, EJ. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients. Chest 1991;100:783–791.CrossRefGoogle ScholarPubMed
93.Bergmans, DCJJ, Bonten, MJM, Gaillard, CA, et al.Prevention of ventilator associated pneumonia by oral decontamination: a prospective, randomised, double-blind, placebo-controlled study. Am J Respir Crit Care Med 2001;164:382–388.CrossRefGoogle Scholar
94.Bion, JF, Badger, I, Crosby, HA, et al.Selective decontamination of the digestive tract reduces gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation. Crit Care Med 1994;22:40–49.CrossRefGoogle Scholar
95.Blair, P, Rowlands, BJ, Lowry, K, Webb, H, Armstrong, P, Smilie, J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 1991;110:303–310.Google Scholar
96.Boland, JP, Sadler, DL, Stewart, W, Wood, DJ, Zerick, W, Snodgrass, KR. Reduction of nosocomial respiratory tract infections in multiple trauma patients requiring mechanical ventilation by selective parenteral and enteral antisepsis regimen (SPEAR) in intensive care. Presented at the 17th Congress of Chemotherapy; 1991; Berlin, Germany.Google Scholar
97.Brun-Buisson, C, Legrand, P, Rauss, A, et al.Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Ann Intern Med 1989;110:873–881.CrossRefGoogle ScholarPubMed
98.Cerra, FB, Maddaus, MA, Dunn, DL, et al.Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 1992;127:163–169.CrossRefGoogle ScholarPubMed
99.Cockerill, FR III, Muller, SR, Anhalt, JP, et al.Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 1992;117:545–553.CrossRefGoogle ScholarPubMed
100.Finch, RG, Tomlinson, P, Holliday, M, Sole, K, Stack, C, Rocker, G. Selective decontamination of the digestive tract (SDD) in the prevention of secondary sepsis in a medical/surgical intensive care unit. Presented at the 17th International Congress of Chemotherapy; 1991; Berlin, Germany.Google Scholar
101.Gastinne, H, Wolff, M, Delatour, F, Faurisson, F, Chevret, S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992;326:594–599.CrossRefGoogle ScholarPubMed
102.Georges, B, Mazerolles, M, Decun, J-F, et al.Décontamination digestive sélective résultats d'une étude chez le polytraumatisé. Réanimation Soins Intensifs Médecin d’Urgence 1994;3:621–627.Google Scholar
103.Hunefeld, G. Klinische Studie zur selektiven Darmdekolonisation bei 204 langzeitbeatmeten abdominal und unfallchirurgischen Intensivpatienten. Anaesthesiologie und Reanimation 1989;14:131–153.Google Scholar
104.Jacobs, S, Foweraker, JE, Roberts, SE. Effectiveness of selective decontamination of the digestive tract (SDD) in an ICU with a policy encouraging a low gastric pH. Clinical Intensive Medicine 1992;3:52–58.Google Scholar
105.Kerver, AJH, Rommes, JH, Mevissen-Verhage EAE, et al.Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 1988;16:1087–1093.CrossRefGoogle ScholarPubMed
106.Korinek, AM, Laisne, MJ, Raskine, L, Deroin, V, Sanson-Lepors, MJ. Selective decontamination of the digestive tract in neurosurgical care unit patients: a double blind, randomized, placebo-controlled study. Crit Care Med 1993;21:1466–1473.CrossRefGoogle ScholarPubMed
107.Krueger, WA, Lenhart, F-P, Neeser, G, et al.Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 2002;166:1029–1037.CrossRefGoogle ScholarPubMed
108.Langlois-Karaga, A, Bues-Charbit, M, Davignon, A, et al.Selective digestive decontamination in multiple trauma patients: cost and efficacy. Pharm World Sci 1995;17:12–16.CrossRefGoogle ScholarPubMed
109.Mandelli, M, Mosconi, P, Langer, M, Cigada, M. Intensive care unit group of infection control: prevention of pneumonia in the intensive care unit. A randomized multicenter clinical trial. Crit Care Med 1989;17:501–505.CrossRefGoogle ScholarPubMed
110.Nouira, S, Marghli, S, Belghith, M, Besbes, L, Elastrous, S, Abroug, F. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbations requiring mechanical ventilation: a randomised placebo controlled trial. Lancet 2001;358:2020–2025.CrossRefGoogle ScholarPubMed
111.Palomar, M, Alvarez-Lerma, F, Jorda, R, Bermejo, B. Prevention of nosocomial infection in mechanically ventilated patients: selective digestive decontamination versus sucralfate. Clinical Intensive Care 1997;8:228–235.CrossRefGoogle Scholar
112.Pneumatikos, I, Koulouras, V, Nathanail, C, Goe, D, Nakos, G. Selective decontamination of the subglottic area in mechanically ventilated patients with multiple trauma. Intensive Care Medicine 2002;28:432–437.CrossRefGoogle ScholarPubMed
113.Pugin, J, Auckenthaler, R, Lew, DP, Suter, PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. JAMA 1991;265:2704–2710.CrossRefGoogle ScholarPubMed
114.Quinio, B, Albanese, J, Bues-Charbit, M, Viviand, X, Martin, C. Selective decontamination of the digestive tract in multiple trauma patients: prospective, double blind, randomized, placebo-controlled study. Chest 1996;109:765–772.CrossRefGoogle ScholarPubMed
115.Rocha, LA, Martin, MJ, Pita, S, et al.Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. Intensive Care Medicine 1992;18:398–404.CrossRefGoogle ScholarPubMed
116.Rodriguez-Roldan, JM, Altuna-Cuesta, A, Lopez, A, et al.Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 1990;18:1239–1242.CrossRefGoogle ScholarPubMed
117.Rolando, N, Gimson, A, Wade, J, Philpott-Howard, J, Casewell, M, Williams, R. Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant hepatic failure. Hepatology 1993;17:196–201.CrossRefGoogle Scholar
118.Sanchez-Garcia, M, Cambronera, JA, Lopez-Diaz, J, et al.Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients: a randomized, double-blind, placebo-controlled multicenter trail. Am Rev Respir Dis 1998;158:908–916.CrossRefGoogle Scholar
119.Sirvent, JM, Torres, A, El-Ebiary, M, Castro, P, de Batile, J, Bonet, A. Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 1997;155:1729–1734.CrossRefGoogle ScholarPubMed
120.Ulrich, C, Harinck-deWeerd, JE, Bakker, NC, Jaez, K, Doornbos, L, de Ridder, VA. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Medicine 1989;15:424–431.CrossRefGoogle ScholarPubMed
121.Unertl, K, Ruckdeschel, G, Selbmann, HK, et al.Prevention of colonization and respiratory infections in long term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 1987;13:106–113.CrossRefGoogle ScholarPubMed
122.Verwaest, C, Verhaegen, J, Ferdinande, P, et al.Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit. Crit Care Med 1997;25:63–71.CrossRefGoogle Scholar
123.Wiener, J, Itokazu, G, Nothan, C, Kabins, SA, Weinstein, RA. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination in a medical-surgical intensive care unit. Clin Infect Dis 1995;20:861–867.CrossRefGoogle Scholar
124.Winter, R, Humphreys, H, Pick, A, MacGowan, AP, Willatts, SM, Speller, DCE. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother 1992;30:73–87.CrossRefGoogle ScholarPubMed
125.Ferrer, M, Torres, A, Gonzales, J, et al.Utility of selective digestive decontamination in mechanically ventilated patients. Ann Intern Med 1994;120:389–395.CrossRefGoogle ScholarPubMed
126.Garbino, J, Lew, DP, Romand, J-A, Hugonnet, S, Auckenthaler, R, Pittet, D. Prevention of severe Candida infections in nonneutropaenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial of patients treated by selective digestive decontamination. Intensive Care Medicine 2002;28:1708–1717.CrossRefGoogle Scholar
127.Hammond, JMJ, Potgieter, PD, Saunders, GL, Forder, AA. Double blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992;340:5–9.CrossRefGoogle ScholarPubMed
128.Laggner, AN, Tryba, M, Georgopoulos, A, et al.Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate? Wien Klin Wochenschr 1994;106:15–19.Google ScholarPubMed
129.Lingnau, W, Berger, J, Javorsky, F, Lejeune, P, Mutz, N, Benzer, H. Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial. J Trauma 1997;42:687–694.CrossRefGoogle ScholarPubMed
130.Nardi, G, Di Silvestre, A, De Monte, A, et al.Reduction in gram-positive pneumonia and antibiotic consumption following the use of a SDD protocol including nasal and oral mupirocin. Eur J Emerg Med 2001;8:203–214.CrossRefGoogle Scholar
131.Stoutenbeek, CP, Van Saene, HKF, Zandstra, DF. Prevention of multiple organ failure by selective decontamination of the digestive tract in multiple trauma patients: the immune consequences of trauma, shock and sepsis. In: Faist, E, Baue, AE, Schildberg, FW, eds. Mechanisms and Therapeutic Approaches. Berlin: Pabst Science; 1996.Google Scholar
132.Tetteroo, GWM, Wagenvoort, JHT, Castelei, A, Tilanus, HW, Ince, C, Braining, HA. Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet 1990;335:704–707.CrossRefGoogle ScholarPubMed
133.Cook, DJ, Laine, LA, Guyatt, GH, et al.Nosocomial pneumonia and the role of gastric pH: a meta-analysis. Chest 1991;100:7–13CrossRefGoogle ScholarPubMed
134.Cook, DJ, Reeve, BK, Guyatt, GH, et al.Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996;275:308–314.CrossRefGoogle ScholarPubMed
135.Messori, A, Tripploi, S, Vaiani, M, Gorini, M, Corrado, A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 2000;321:1103–1106.CrossRefGoogle ScholarPubMed
136.Cook, DJ, De Jonghe, B, Brochard, L, Brun-Buisson, C. Influence of airway management on ventilation associated pneumonia: evidence from randomized trials. JAMA 1998;279:781–787.CrossRefGoogle ScholarPubMed
137.Marik, PE, Fink, MP. One good turn deserves another! Crit Care Med 2002;30:2146–2148.CrossRefGoogle Scholar
138.Heyland, DK, Cook, DJ, Jaescher, R, Griffith, L, Lee, HN, Guyatt, GH. Selective decontamination of the digestive tract: an overview. Chest 1994;105:1221–1229.CrossRefGoogle ScholarPubMed
139.Hurley, JC. Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection? Antimicrob Agents Chemother 1995;39:941–947.CrossRefGoogle ScholarPubMed
140.Kollef, M. The role of selective digestive tract decontamination in mortality and respiratory tract infections: a meta-analysis. Chest 1994;105:1101–1108.CrossRefGoogle ScholarPubMed
141.Liberati, A, D'Amico, R, Pifferi, S, Torri, V, Brazzi, L. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care (Cochrane Review). In: The Cochrane Library, issue 1. Chichester, United Kingdom: John Wiley & Sons; 2004.Google Scholar
142.van Nieuwenhoven, CA, Buskens, E, van Tiel, FH, Bonten, MJM. Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients. JAMA 2001;286:335–340.CrossRefGoogle ScholarPubMed
143.Vandenbroucke-Grauls, CM, Vandenbroucke-Grauls, JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 1991;338:859–862.CrossRefGoogle ScholarPubMed
144.Merrer, J, Santoli, F, Vecchi, CA, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718–723.CrossRefGoogle Scholar
145.Weist, K, Pollege, K, Schulz, I, Rüden, H, Gastmeier, P. How many nosocomial infections are associated with cross-transmission? A prospective cohort study in a surgical intensive care unit. Infect Control Hosp Epidemiol 2002;23:127–132.CrossRefGoogle Scholar
146.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.CrossRefGoogle ScholarPubMed
147.Jarvis, WR. Nosocomial outbreaks: the Center for Disease Control's Hospitals Infections Program experience, 1980-1990. Am J Med 1991;91(suppl):101S–106S.CrossRefGoogle Scholar
148.Cook, DJ, Kollef, MH. Risk factors for ICU-acquired pneumonia. JAMA 1998;279:1605–1606.CrossRefGoogle ScholarPubMed
149.George, DL. Epidemiology of nosocomial ventilator-associated pneumonia. Infect Control Hosp Epidemiol 1993;14:163–169.CrossRefGoogle ScholarPubMed