Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Withholding selective decontamination of the digestive tract from critically ill patients must now surely be ethically questionable given the vast evidence base. | Zandstra et al. Critical Care 2010 14 443 http content 14 5 443 c CRITICAL CARE LETTER Open Access Withholding selective decontamination of the digestive tract from critically ill patients must now surely be ethically questionable given the vast evidence base rii irlc F ndrtrs 1A mcl I Pcstrmc2 ivli .i Ttst lcsr3 I I cisms dlx cictri4 i lici lũ A do H n 5 UondricF Fl- nm dũi d3 Durk F Zdiiusiid Andy J Petros Nid Idylor Lucidno Silvestri Miguel A de Id Cdl Hendrick r vdii Sdene See related Journal club critique by Shibli et al. http eontent 14 3 314 Shibli and colleagues recently commented 1 on the Dutch randomised controlled trial in which selective digestive decontamination SDD and selective oropharyngeal decontamination SOD were associated with significantly lower odds of death as compared with standard care with odds ratios of P and P respectively 2 . We disagree with the authors conclusion that because there were similar mortality reductions SOD may be preferred as this avoids routinely exposing patients to intravenous antibiotics and involves less resistance. Cephalosporin consumption was higher in the SDD group but defined daily doses of penicillins carba-penems quinolones and other antibiotics increased by 31 37 25 and 15 respectively in SOD compared with SDD in the Dutch randomised controlled trial 2 . In citing the monthly point prevalence su rvey 3 of the Dutch randomised controlled trial Shibli and colleagues failed to mention that the average prevalence of aerobic Gram-negative bacilli resistant to ceftazidime tobramycin and ciprofloxacin in the respiratory tract was significantly lower during SDD SOD than in the pre-intervention and post-intervention periods and that aerobic Gram-negative bacilli resistance to ciprofloxacin and tobramycin in rectal swabs was significantly reduced during SDD compared with standard care SOD 2 3 . Finally two recent meta-analyses evaluated the effectiveness of SDD 4 and of SOD
