Systemic antibiotic prophylaxis

A short-term systemic antibiotic prophylaxis is generally given during the first 3 to 4 days of SDD treatment with the following objectives:

1. elimination from the oropharynx of Gram-positive potentially pathogenic micro-organisms which are insensitive to the topical antibiotics (e.g. pneumococci, hemolytic streptococci);

2. early treatment or prophylaxis of primary endogenous infections in the first few days when the decontamination is not yet complete.

Early-onset infections in mechanically ventilated intensive care patients are invariably caused by potentially pathogenic micro-organisms carried by the patient in the throat or gastrointestinal tract and aspirated before or during intubation (i.e. primary endogenous infections). Primary endogenous infections, occurring mainly within the first 4 days in the ICU, constitute about 50 per cent of all respiratory infections developing in intensive care when no systemic antibiotic prophylaxis is given. Primary endogenous infections in patients who have not previously been in hospital (e.g. multiple trauma patients) are mostly caused by Strep. pneumoniae, H. influenzae, Staph. aureus and E. coli, whereas species from the Klebsiella-Enterobacter group are more frequently found in patients who have been in hospital prior to admission to the ICU.

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