Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding: Bacterial colonization of the stomach

Kappstein, Ines; Schulgen, Gabi; Friedrich, Thomas; Hellinger, Peter; Benzing, A.; Geiger, K.; Daschner, Franz

doi:10.1016/0002-9343(91)90464-9

Cited by 92 publications

(33 citation statements)

References 10 publications

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“…It is unlikely that the gastric barrier is functioning effectively using sucralfate, because 75% of sucralfatetreated patients had gastric pH levels between 3.5 and 4.5 [22]. As a consequence relatively high gastric colonization rates in sucralfate treated patients are found (C. albicans 49~ Gram-negative bacilli 48.8%; S. aureus 24.5~ [22].…”

Section: Alternatives To Sddmentioning

confidence: 92%

“…No significant effect of sucralfate on morbidity or mortality has been found. However, in these studies sucralfate had no effect on the carriage of Gram-negative bacilli or S. aureus in the throat and in the majority of sucralfate-treated patients the trachea was still colonized by Gram-negative PPM or S. aureus [20,22]. Therefore the diagnosis of infection relied heavily on the clinical criteria of infection.…”

Section: Alternatives To Sddmentioning

confidence: 95%

“…A number of studies [20][21][22] have shown that sucralfate, which has no influence on the gastric pH, decreases pneumonia rate compared to Hrblockers or antacids. No significant effect of sucralfate on morbidity or mortality has been found.…”

Section: Alternatives To Sddmentioning

confidence: 98%

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Prevention of pneumonia by selective decontamination of the digestive tract (SDD)

Stoutenbeek

Saene

1992

Intensive Care Med

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Prevention of respiratory tract infections is only possible when the pathogenesis is known. Three types of infection can be distinguished: primary endogenous infections, caused by pathogens carried in the throat at the commencement of mechanical ventilation, generally develop early and can only be prevented by intravenous antibiotics. Secondary endogeneous infections, caused by hospital-acquired pathogens, generally develop later and can be prevented by selective decontamination of the digestive tract (SDD). The GI-tract is decontaminated by oral nonabsorbable antibiotics and for oropharyngeal decontamination a sticky antibiotic ointment is used. To date 16 controlled SDD trials in intensive care have been fully published. In all except one study, the pneumonia rate decreased significantly from 40%-50% in controls to about 10% in SDD-treated patients. All studies showed a consistent reduction of ventilator days, ICU-stay and an improved outcome in SDD-treated patients. However, in only few studies did these differences reach statistical significance. Selection of resistant strains has not been observed during prolonged use of SDD. Sucralfate reduces the pneumonia rate compared to H2-blockers or antacids by not interfering with the gastric barrier. However, gastric colonization is reduced rather than eliminated and sucralfate has almost no effect on oropharyngeal or tracheal colonization. Whether sucralfate is significantly better than a placebo remains to be established. SDD is superior to sucralfate in preventing both colonization and infection.

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Section: Alternatives To Sddmentioning

confidence: 92%

Section: Alternatives To Sddmentioning

confidence: 95%

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Prevention of pneumonia by selective decontamination of the digestive tract (SDD)

Stoutenbeek

Saene

1992

Intensive Care Med

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“…Although the frequency of stress bleeding appears to have decreased over the past two decades, most mechanically ventilated, intensive care unit patients continue to receive prophylaxis. Randomized studies of stress bleeding prophylaxis in mechanically ventilated, critical ynx and arynx $5 care patients have suggested equal efficacy and decreased rates of pneumonia for patients given sucralfate versus antacids or H2 blockers [15,18,38,39].…”

Section: Gastric Colonizationmentioning

confidence: 99%

Nosocomial pneumonia: Epidemiology and infection control

et al. 1992

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Elderly, debilitated, or critically ill patients are at high risk for hospital acquired or nosocomial respiratory tract infection. Gram-negative bacilli, Staphyloccoccus aureus, and anaerobes colonizing the oropharynx are the most frequent etiologic agents. Colonization of the oropharynx may be related to the patient's age, underlying disease, nutritional status, prior exposure to antibiotics, supine position, and gastric colonization. Nosocomial pathogens may also be acquired from the hands of hospital personnel, contaminated equipment or fluids. The absence of sensitive and specific methods for accurate diagnosis remain a concern. Despite treatment with appropriate antimicrobial therapy, there is a high mortality and morbidity. Measures for the prevention of nosocomial pneumonia should include compliance with infection control principles, appropriate use of antibiotics, proper patient position, and removal of potential sources of cross colonization.

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“…Because of these issues, we do not believe that a clear interpretation of the study done by Driks et al (13) can be made. Other studies of mechanically ventilated patients have found that patients who received H2 receptor blockers for stress ulcer prophylaxis had a higher incidence of pneumonia than patients who received sucralfate (31,45). A randomized study of mechanically ventilated patients that compared stress ulcer prophylaxis with antacids, ranitidine, and sucralfate found no difference in the incidence of early-onset (within 4 days of entry into the ICU) nosocomial pneumonia among the three groups (45).…”

mentioning

confidence: 95%