Abstract
Nosocomial pneumonias, especially in ventilated patients, are a continuing problem in modern medicine. Pathogens most commonly involved with these pneumonias areEnterobacteriaceae, Ps. aeruginosa andS. aureus. Several prevention measures for nosocomial pneumonia are possible such as parenteral and topical antibiotics—a very controversial issue. Several studies with parenteral antibiotics, starting as early as 1954, could not prove any benefit of parenteral antibiotics in pneumonia prevention. Topical antibiotics, starting with polymyxin or gentamicin via the endotracheal tube in the 70s, gave controversial results. In a prospective, randomized, double-blind placebo controlled study with gentamicin via the endotracheal tube in ventilated ICU patients we found no significant reduction of pneumonia rate and mortality. However, the combined, approach (SDD) of oropharyngeal, gastrointestinal and parenteral use of certain antibiotics appears to give promising results in specific patient subgroups such as ventilated polytrauma patients in ICU.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Craven DE, Kunches IM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR (1986) Risk factors for pneumonia and fatality in patients receiving continous mechanical ventilation. Am Rev Respir Dis 133:792–796
Garibaldi RA, Britt MR, Coleman ML, Reading JC, Pace NL (1981) Risk factors for postoperative pneumonia. Am J Med 70:677–680
Bell RC, Coalson JJ, Smith JD, Johanson WG Jr (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99:293–298
Meduri GU (1990) Ventilator-associated pneumonia in patients with respiratory failure. Chest 97:1208–1219
Cross AS, Roup B (1981) Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 70:681–685
Pennington JE (1988) Hospital-acquired pneumonia and respiratory infection: diagnosis and management, 2nd edn. Raven Press, New York, 171–186
Van Uffelen R, Rommes JH, van Saene HKF (1987) Preventing lower airway colonization and infection in mechanically ventilated patients. Crit Care Med 15:99–102
Shield MJ, Hammill HJ, Neale DA (1979) Systemic bacteriological monitoring of intensive care unit patients: the results of a twelve-month study. Intensive Care Med 5:171–175
Johanson WG, Pierce AK, Sandford JP, Thomas GD (1972) Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 77:701–706
Abraham SN, Beachey EH, Simpson WA (1981) Adherence ofStreptococcus pyrogenes, Escherichia coli andPseudomonas aeruginosa to buccal cells. J Infect Dis 143:784–790
Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1987) Colonization and infection in surgical intensive care patients—a prospective study. Intensive Care Med 13:347–351
Thorp JM, richards WC, Telfer ABM (1979) A survey of infection in an intensive care unit. Anaesthesia 34:643–650
Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1988) Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 16:1087–1093
Johanson WG, Seidenfeld JJ, de los Santos R, Coalson JJ, Gomez P (1988) Prevention of nosocomial pneumonia using topical and parenteral antimicrobial agents. Am Rev Respir Dis 137:265–269
Van Saene HKF, Stoutenbeek CP (1987) Selective decontamination. J Antimicrob Chemother 20:462–465
Bryan CS, Reynolds UL (1984) Bacteremic nosocomial penumonia Am Rev Respir Dis 129:668–671
Lepper MH, Dowling H, Jackson GG et al (1954) Antibiotic prophylaxis of pneumonia in tracheotomized poliomyelitis patients. N Engl J Med 251:587–591
Petersdorf RG, Curtin JA, Hoeprich PD, Peeler RN, Bennett JL (1957) A study of antibiotic prophylaxis in unconscious patients. N Engl J Med 257:1001–1009
Petersdorf RG, Curtin JA, Hoeprich DD, Bennett IL (1965) Double-blind placebo controlled trial of antibiotic prophylaxis of pneumonia. N Engl J Med 263:689–694
Mandelli M, Mosconi O, Langer M, Cigada M, Intensive Care Unit Group of Infection Control (1989) Prevention of pneumonia in an intensive care unit: a randomized multicenter clinical trial. Crit Care Med 17:501–505
Septimus EJ (1989) Nosocomial bacterial pneumonias. Sem Respir Infect 4:245–252
Haley RW, Culver DH, White JW et al (1985) The nationwide nosocomial infection rate: a new need for vital statistic. Am J Epidemiol 121:159–167
Klick JM, du Moulin GC, Hedley-Whyte J, Teres D, Bushnell LS, Feingold DS (1975) Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. II. Effect on the incidence of pneumonia in seriously ill patients. J Clin Invest 55:514–519
Feeley TW, duMoulin GC, Hedley-Whyte J, Bushnell LS, Gilbert JP, Feingold DS (1975) Aerosol polymyxin and pneumonia in seriously ill patient. N Engl J Med 293:471–475
Levine BA, Petroff PA, Slade CL et al (1978) Prospective trials of dexamethasone and aerosolized gentamicin in the treatment of inhalation injury in the burned patients. J Trauma 18:188–193
Klastersky J, Huysmans E, Weert D, Hensgens C, Daneau D (1974) Endotracheally administered gentamincin for the prevention of infections of the respiratory tract in patients with tracheostomy: a double-blind study. Chest 65:650–654
Klastersky J, Genning E, Mourawad D, Daneau D (1972) Endotracheal gentamycin in bronchial infection in patients with tracheostomy. Chest 61:117–120
Crouch TW, Higuchi JH, Coalsen JJ et al (1984) Pathogenesis and prevention of nosocomial pneumonia in a nonhuman primate model of acute respiratory failure. Am Rev Respir Dis 130:502–504
Stoutenbeek CP, Van Saene HKF, Miranda DR et al (1987) The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357–364
Unertl K, Ruckdeschel G, Selbmann HK, Jensen U, Forst H, Lenhart FP, Peter K (1987) Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 13:106–113
Ledingham IM, Alcock SR, Eastaway AT, McDonald JC, McKay IC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime and microbiological surveillance for prevention of acquired infection in intensive care. Lancet I:785–790
Vogel F, Werner H, Exner M, Marx M (1981) Prophylaxe und Therapie von Atemwegsinfektionen bei beatmeten, Patienten durch intratracheale Aminoglycosidgabe. Dtsch Med Wochenschr 106:899–933
Vogel F, Rommelsheim K, Kühnen E, Exner M (1987) Dekontamination der Atemwege durch lokale Antibiotikaanwendung. In: Lode H, Nolte D (Hrsg). Pneumonie—Diagnostik—Klinik—Therapie, Symposium Berlin 1986. Thieme, Stuttgart New York, S 145–153
Lode H, Goecke J, The PEG-Endotracheal Gentamicin Study Group (1988) Endotracheal application of gentamicin: randomized placebo-controlled double-blind study in ventilated patients. 28th Interscience Conference on Antimicrobial Agnets and Chemotherapy, Los Angeles, October 1988, Abstract 30.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lode, H., Höffken, G., Kemmerich, B. et al. Systemic and endotracheal antibiotic prophylaxis of nosocomial pneumonia in ICU. Intensive Care Med 18 (Suppl 1), S24–S27 (1992). https://doi.org/10.1007/BF01752973
Issue Date:
DOI: https://doi.org/10.1007/BF01752973