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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: Endothelial Selective digestive decontamination is superior to selective oropharyngeal decontamination. | Silvestri et al. Critical Care 2011 15 411 http ccforum.eom content 15 2 411 CRITICAL CARE LETTER L_ Selective digestive decontamination is superior to selective oropharyngeal decontamination Luciano Silvestri 1 Nia Taylor2 Durk F Zandstra3 and Hendrick KF van Saene2 See related research by Schultz and Haas http ccforum.Com content 15 1 R18 We are interested in the debate on the efficacy and safety of selective digestive decontamination SDD and selective oropharyngeal decontamination SOD raised by Schultz and Haas in their review 1 . The authors concluded that SDD and SOD are equally effective with respect to the prevention of mortality 1 . This statement is based on the results of a Dutch randomized controlled trial 2 which was the first to demonstrate a survival benefit of SOD. However the mortality reduction was higher albeit not significantly in the SDD group than in the SOD group. Additionally a recent meta-analysis including nine SOD randomized controlled trials and 4 733 patients failed to show any significant mortality reduction odds ratio OR 0.93 95 confidence interval CI 0.81 to 1.07 3 . In contrast there is robust evidence indicating that SDD including parenteral and enteral antimicrobials significantly reduces mortality 4 . The authors wrote that whether SDD or SOD are favorable with regard to development of antibiotic resistance is yet unknown 1 . The Dutch randomized controlled trial however showed that patients with aerobic Gram-negative bacilli in rectal swabs resistant to the marker antibiotics numbered less with SDD than with SOD 2 . Additionally bacteremia due to highly resistant pathogens was significantly reduced by SDD compared with SOD OR 0.37 95 CI 0.16 to 0.85 and lower respirat ory tract colonization due to highly resistant pathogens was lower with SDD OR 0.58 95 CI 0.43 to 0.78 than with SOD OR 0.65 95 CI 0.49 to 0.87 compared with standard care 5 . We believe that SDD is superior to SOD in terms of both mortality reduction and .
