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Báo cáo y học: "Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia: a literature review"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia: a literature review. | Schultz and Haas Critical Care 2011 15 R18 http ccforum.eom content 15 1 R18 cs CRITICAL CARE RESEARCH Open Access Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia a literature review Marcus J Schultz1 2 3 Lenneke E Haas1 Abstract Introduction Mechanically ventilated critically ill patients frequently develop ventilator-associated pneumonia VAP a life-threatening complication. Proposed preventive measures against VAP include but are not restricted to selective decontamination of the digestive tract SDD selective oropharyngeal decontamination SOD and the use of probiotics. Probiotics are live bacteria that could have beneficial effects on the host by altering gastrointestinal flora. Similar to SDD and SOD a prescription of probiotics aims at the prevention of secondary colonization of the upper and or lower digestive tract. Methods We performed a literature review to describe the differences and similarities between SDD SOD and probiotic preventive strategies focusing on a efficacy b risks and c the routing of these strategies. Results Reductions in the incidence of VAP have been achieved with SDD and SOD. Two large randomized controlled trials even showed reduced mortality with these preventive strategies. Randomized controlled trials of probiotic strategies also showed a reduction of the incidence of VAP but trials were too small to draw firm conclusions. Preventive strategies with antibiotics and probiotics may be limited due to the risk of emerging resistance to the locally applied antibiotics and the risk of probiotic-related infections respectively. The majority of trials of SDD and SOD did not exhaustively address the issue of emerging resistance. Likewise trials of probiotic strategies did not adequately address the risk of colonization with probiotics and probiotic-related infection. In studies of SDD and SOD the preventive strategy aimed at decontamination of the oral cavity throat stomach and intestines and the oral