***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this prospect i ve , r and omized , double-blind study was to evaluate the effect of the addition of mupirocin to the ‘ classical ’ topical SDD regimen ( tobramycin 80 mg , polymyxin E 100 mg , amphotericin B 500 mg ) on the development of ICU-acquired infections due to Gram-positive bacteria . The study was carried out in an intensive care unit ( ICU ) of a 1400-bed community hospital . All patients admitted to the ICU during a 16-month period , who were expected to require mechanical ventilation for more than 24 hours , were r and omized to receive either the ‘ classical ’ SDD regimen ( Group A ) or a modified regimen with mupirocin ( Group B ) . Data from 223 patients requiring mechanical ventilation for at least 48 hours , who were neither infected nor receiving antibiotics on ICU admission , was analysed . A 2 % paste containing tobramycin , polymyxin E and amphotericin B was applied every 6 hours in the oropharynx to the patients in Group A , while in Group B this formula was modified with the addition of 2 % mupirocin . In Group B 0.2 ml of a 2 % mupirocin ointment was also applied four times daily in both nostrils . Patients in Group A received a soft paraffin ointment as a placebo indistinguishable from mupirocin . Patients in both groups received the classic SDD regimen through the nasogastric tube . Systemic antibiotic prophylaxis was not used . Data on lower airway infection , and blood infection , infections of intravascular catheters , antibiotic consumption and expenditures for antibiotics were analysed . The diagnosis of ventilator-associated pneumonia ( VAP ) was based on quantitative cultures of protected specimen brush sample s ( PSB ) or on the results of distal broncho-alveolar lavage ( BAL ) . One hundred and four patients received the ‘ classical ’ SDD and 119 the modified regimen . Overall 29 patients , 20 in Group A and nine in Group B ( p < 0.02 ) had a total of 33 cases of pneumonia . There were 23 episodes of pneumonia in Group A and 10 in Group B ( p < 0.02 ) . Gram-positive bacteria were isolated from sample s in 17 episodes in Group A and six in Group B ( p < 0.02 ) . Staphylococcus aureus was isolated in nine cases of pneumonia in Group A and once in the ‘ mupirocin ’ group ( p < 0.05 ) . MRSA were isolated in seven out of nine cases in Group A and in the only case in Group B. There were no differences in the isolation of Gram-negative bacilli . Antibiotic consumption and cost were lower in Group B. In conclusion , our data show that the topical use of a modified formula of SDD , with the addition of mupirocin to the oral paste and in the anterior nares , is associated with a reduction in lung infections caused by gram-positives and in a reduction in antibiotic consumption and in the overall expenditure for antibiotics To evaluate the use of selective decontamination of the digestive tract ( SDD ) ( polymyxin , amphotericin , tobramycin , and intravenous cefotaxime ) in a mixed intensive care unit , we performed a stratified , r and omized , prospect i ve study . The 331 patients were recruited over an 18-month period , with 256 patients remaining more than 48 hours . Stratification by acute physiology and chronic health evaluation ( APACHE II ) preceded r and omization to control ( st and ard antibiotic therapy ) or treatment ( SDD ) groups . Nosocomial infection was significantly reduced in the SDD group ( 16.7 % ; 21 of 126 patients ) compared with the control group ( 30.8 % ; 40 of 130 patients ; p = 0.008 ) . No difference was found in overall mortality rate or length of stay between the two groups . Those patients with admission APACHE II scores 10 to 19 demonstrated the most significant reduction in nosocomial infection ( 23 of 70 control vs 13 of 76 SDD ; p = 0.03 ) and mortality ( 15 of 70 control vs 8 of 76 SDD ; p = 0.07 ) . Emergence of multiresistant microorganisms was not a clinical problem , but a definite change occurred in the ecology of environmental and colonizing bacteria . With the exception of cefotaxime , a reduction was noted in systemic antibiotic usage in the SDD group . We conclude that SDD is useful in selected patients in a mixed intensive care unit Nonabsorbable antibiotics for selective bowel decontamination ( SBD ) sometimes are administered to liver transplant patients to prevent postoperative infections , but the efficacy of SBD is not known . Accordingly , we prospect ively studied 69 patients r and omly assigned to receive conventional prophylaxis with systemic antibiotics ( control patients ) or conventional prophylaxis plus oral nonabsorbable antibiotics for SBD ( SBD patients ) .  Overall rates of bacterial and /or yeast infections were nearly equal among control patients ( 42 % ) and SBD patients ( 39 % ) . However , the infection rate at SBD key sites ( abdomen , bloodstream , surgical wound , and lungs ) was lower among patients who received the SBD regimen > or = 3 days before transplantation ( 23 % ) than among control patients ( 36 % ) . Administration of the SBD regimen was complicated by gastrointestinal intolerance and noncompliance but not by increased stool colonization with antibiotic-resistant gram-negative bacilli . Practical problems associated with administering an SBD regimen to patients awaiting cadaver liver transplants limit the regimen 's usefulness , but we found a trend toward reduced key site infection when the regimen was given > or = 3 days before transplantation BACKGROUND Selective digestive tract decontamination ( SDD ) and selective oropharyngeal decontamination ( SOD ) are infection-prevention measures used in the treatment of some patients in intensive care , but reported effects on patient outcome are conflicting . METHODS We evaluated the effectiveness of  SDD and SOD in a crossover study using cluster r and omization in 13 intensive care units ( ICUs ) , all in The Netherl and s. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible . In each ICU , three regimens ( SDD , SOD , and st and ard care ) were applied in r and om order over the course of 6 months . Mortality at day 28 was the primary end point . SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin , colistin , and amphotericin B in the oropharynx and stomach . SOD consisted of oropharyngeal application only of the same antibiotics . Monthly point-prevalence studies were performed to analyze antibiotic resistance . RESULTS A total of 5939 patients were enrolled in the study , with 1990 assigned to st and ard care , 1904 to SOD , and 2045 to SDD ;  crude mortality in the groups at day 28 was 27.5 % , 26.6 % , and 26.9 % , respectively . In a r and om-effects logistic-regression model with age , sex , Acute Physiology and Chronic Health Evaluation ( APACHE II ) score , intubation status , and medical specialty used as covariates , odds ratios for death at day 28 in the SOD and SDD groups , as compared with the st and ard-care group , were 0.86 ( 95 % confidence interval [ CI ] , 0.74 to 0.99 ) and 0.83 ( 95 % CI , 0.72 to 0.97 ) , respectively . CONCLUSIONS In an ICU population in which the mortality rate associated with st and ard care was 27.5 % at day 28 , the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD . ( Controlled Clinical Trials number , IS RCT N35176830 . Infection is still one of the leading causes of morbidity and mortality in severely burned patients . Evidence suggests that many of the responsible organisms are endogenous . Systemic antibiotic prophylaxis is not effective , and produces resistant strains of microorganisms . SDD has been postulated to be beneficial for controlling and decreasing infections in critically ill patients . Its efficacy in severely burned patients , however , remains controversial . In order to analyze the efficacy of selective decontamination of the digestive ( SDD ) tract , to decrease the bacterial colonization of the aerodigestive tract and burn wounds , and the incidence of septic complications in severely burned children , 23 pediatric patients affected of severe burns were prospect ively r and omized in a double-blinded study . Eleven patients received  SDD ( Polymyxin E , Tobramycin , and Amphotericin B ) , and 12 placebo .  Demographics , hospital course , microbiology results , complications , infectious episodes , and serum levels of IL-1beta , IL-6 , IL-10 , and TNF-alpha were compared to determine the efficacy of SDD .  Colonization rates to the wound , sputum , nasogastric aspirates , and feces were similar . Pneumonia , sepsis and other complications had similar incidence in both groups . Serum levels of all cytokines studied were also comparable , suggesting a similar inflammatory status in all patients , regardless of the treatment received . Patients in the SDD group , however , had a significantly higher incidence of diarrhea ( P=0.003 ) . We can conclude that selective decontamination of the digestive tract with Polymixin E , Tobramycin and Amphotericin B is not effective to decrease bacterial colonization and infectious episodes in severely burned pediatric patients Objective : To evaluate whether selective digestive decontamination ( SDD )  reduces mortality from any cause , and the incidence of pneumonia among patients with severe burns . Summary Background Data : SDD is a prophylactic strategy to reduce infectious morbidity and mortality in critically ill patients . Two meta-analyses and a recent r and omized controlled trial demonstrated a mortality reduction varying between 20 % and 40 % . But this technique has never been properly evaluated in severely burned patients . Methods : The design of this single-center trial was r and omized , double blind , placebo controlled . Patients with burns ≥20 % of total body surface and /or suspected inhalation injury were enrolled and assigned to receive SDD or placebo for the total duration of treatment in the burn intensive care unit ( ICU ) . Results : One hundred seventeen patients were r and omized and 107 were analyzed ( 53 in the SDD group and 54 in the placebo group ) . The ICU mortality was 27.8 % in the placebo group and 9.4 % in the SDD group in the burn ICU . Treatment with SDD was associated with a significant reduction in mortality both in the burn ICU ( risk ratio 0.25 ; 95 % CI 0.08 to 0.76 ) and in the hospital ( risk ratio 0.28 ; 95 % CI 0.10 to 0.80 ) , following adjustment for predicted mortality . The incidence of pneumonia was significantly higher in the placebo group : 30.8 and 17.0 pneumonias per 1000 ventilation days ( P = 0.03 ) in placebo and SDD group , respectively . Conclusions : Treatment with SDD  reduces mortality and pneumonia incidence in patients with severe burns Objective : The use of topical polymyxin and tobramycin to prevent intensive care infections is controversial . Moreover , these antibiotics are ineffective against methicillin-resistant Staphylococcus aureus . A decontamination regimen using mupirocin and chlorhexidine could prevent acquired infections , including those involving S. aureus . Because these two regimens could have a complementary role , we evaluated their effects when given both alone and combined . Design : The authors conducted a multiple-center , placebo-controlled , r and omized , double-blind study performed according to a 2 × 2 factorial design . Setting : The study was conducted at three polyvalent medical intensive care units at university-affiliated hospitals in France . Patients : Adult patients ( age , ≥18 yrs ) intubated for < 48 hrs who were likely to be ventilated for > 48 hrs . Intervention : Two regimens were used : topical administration of polymyxin/tobramycin ( or placebo ) and nasal mupirocin with chlorhexidine body washing ( or nasal placebo with liquid soap ) . The patients ( n = 515 )  received polymyxin/tobramycin alone ( n = 130 ) , mupirocin/chlorhexidine alone ( n = 130 ) , both regimens ( n = 129 ) , or all placebos ( n = 126 ) for the period of mechanical ventilation plus 24 hrs . Measurements and Main Results : The incidence of total infections acquired from the date of r and omization until the termination date of study treatments plus 48 hrs was assessed . There were fewer acquired infections with both regimens than with polymyxin/tobramycin alone ( odds ratio , 0.44 ; 95 % confidence interval , 0.26 
    Output:
    
A combination of topical and systemic prophylactic antibiotics reduces RTIs and overall mortality in adult patients receiving intensive care .
Treatment based on the use of topical prophylaxis alone reduces respiratory infections but not mortality .