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• W4385408412 abstract "What is the effectiveness of topical antibiotic regimens (selective digestive decontamination and selective oropharyngeal decontamination) plus systemic prophylaxis in preventing mortality and respiratory infections in adult patients receiving mechanical ventilation for at least 48 hours in intensive care units?Ventilator-associated pneumonia (VAP) is defined as a lower respiratory tract infection that occurs in patients who receive mechanical ventilation for more than 48 hours. It is one of the most common types of respiratory tract infections in adult patients receiving mechanical ventilation.1,2 The prevalence of VAP ranges from 5% to 40%, depending on the context and diagnostic criteria.1 Outcomes of VAP include increased mortality, hospital length of stay, costs, and stress for patients, families, and hospital staff members.1 Even with advances in diagnosing and managing VAP, global mortality rates have been reported to range from 20% to 75%, with the rate in the United States estimated as 10% to 13%.2 Patients who experience VAP often require additional attention and nursing care during their treatment. Studies have shown that an increase in nursing workload is significantly associated with an increase in the incidence of nosocomial infections, including VAP, and mortality rates.3 Thus, identifying the most effective prevention strategies for infections such as VAP is critical for improving patient outcomes as well as nurse satisfaction.Several approaches can be taken to prevent VAP, including thorough oral care, aspiration of secretions, proper positioning, and the use of prophylactic antibiotics. In using prophylactic antibiotics, one strategy is to focus on the infections caused by microorganisms found in the oral and intestinal tracts.4Two infection prevention strategies that have been effective in eradicating aerobic gram-negative bacteria are selective oropharyngeal decontamination (SOD) and selective decontamination of the digestive tract (SDD). Selective oropharyngeal decontamination includes applying bactericidal nonabsorbable antibiotics, in the form of a topical paste, to the oropharyngeal area 4 times a day. Selective decontamination of the digestive tract includes the same technique as SOD but adds an intestinal suspension containing the same antibiotics given via the nasogastric tube and a several-day course of systemic intravenous antibiotics.4Although SOD and SDD require additional nursing time, the potential benefit of preventing VAP not only improves patient outcomes but also reduces overall nursing workload. Even though high-quality evidence exists to support these approaches, SOD and SDD have not been widely adopted in clinical practice because of concern that they could increase the incidence of antibiotic resistance.5This summary is based on an update to a previously published systematic review conducted in 2009.6 As new evidence on a topic becomes available, updates are necessary to account for the results that the new evidence presents. This update, conducted by Minozzi et al,7 included 41 randomized controlled trials comprising 11 004 adult participants meeting the stated criteria. The primary outcomes investigated in this review were overall mortality and respiratory tract infections (all types, including VAP).Minozzi et al7 independently assessed the risk of bias for each study, including selection, performance, detection, attrition, reporting, and publication biases (through visual inspection of funnel plots). Any disagreements were resolved by reviewing the data together and discussing them. The authors used risk ratios (RRs) with 95% CIs for dichotomous outcomes as measures of treatment effect between various comparisons and outcomes. They used the internationally approved Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to determine the certainty of evidence—high, moderate, low, or very low—for each outcome8: High-certainty evidence indicated a significant decrease in overall mortality in participants who received topical plus systemic prophylaxis compared with placebo or no treatment (RR, 0.84 [95% CI, 0.73-0.96]; 18 studies with 5290 participants).Moderate-certainty evidence indicated a significant decrease in the incidence of respiratory tract infections in participants who received topical plus systemic prophylaxis compared with placebo or no treatment (RR, 0.43 [95% CI, 0.35-0.53]; 17 studies with 2951 participants).Moderate-certainty evidence indicated that there was not a significant difference in overall mortality between participants who received and those who did not receive topical prophylaxis (RR, 0.96 [95% CI, 0.87-1.05]; 22 studies with 4213 participants).Low-certainty evidence indicated a significant reduction in the incidence of respiratory tract infections in participants who received compared with those who did not receive topical prophylaxis (RR, 0.57 [95% CI, 0.44-0.74]; 19 studies with 2698 participants). The low-certainty characterization of the evidence was due to risk of selection and publication bias in the included studies.Low-certainty evidence indicated that there was not a significant difference in overall mortality between participants who received topical prophylaxis plus systemic prophylaxis and those who received only systemic prophylaxis (RR, 0.92 [95% CI, 0.72-1.18]; 7 studies with 939 participants).Low-certainty evidence indicated that there was not a significant difference in overall respiratory infections between participants who received topical prophylaxis plus systemic prophylaxis and those who received only systemic prophylaxis (RR, 0.82 [95% CI, 0.58-1.16]; 6 studies with 850 participants).This review showed that in adult patients receiving mechanical ventilation for at least 48 hours, a combination of topical and systemic prophylactic antibiotics decreased both overall mortality and respiratory tract infections. It is worth noting that the systemic antibiotics used likely had a significant impact on these results. The use of only topical prophylaxis probably reduces respiratory tract infections but does not decrease mortality. Given the risk of antimicrobial resistance as a negative consequence of antibiotic use, this topic warrants future exploration through appropriate comparison studies.The evidence from this systematic review may affect decisions of the clinical care team in the development of treatment plans for patients at risk of VAP and other nosocomial infections. The more options we have for VAP prevention, the greater the potential for improving patient outcomes and controlling nurses’ workload. If nurses understand the topical options for VAP prophylaxis, they can introduce these options to the care team for consideration in individual situations. In every case, it is important to consider the best available evidence and understand the feasibility, appropriateness, and effectiveness of any potential intervention. Advocating for the best evidence-based treatment is a crucial aspect of our role as nurses caring for critically ill patients." @default.
• W4385408412 created "2023-08-01" @default.
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• W4385408412 date "2023-08-01" @default.
• W4385408412 modified "2023-09-27" @default.
• W4385408412 title "Topical Antibiotic Prophylaxis to Reduce Respiratory Tract Infections and Mortality in Adults Receiving Mechanical Ventilation" @default.
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• W4385408412 doi "https://doi.org/10.4037/ccn2023943" @default.
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