***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 
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    Input: 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 Objective : To evaluate the effect of a method of Selective Decontamination of the Digestive Tract ( SDD ) on colonization , nosocomial infection ( NI ) , bacterial resistance , mortality and economic costs . Design : R and omized , double blind , placebo controlled study . Setting : Polyvalent intensive care unit ( ICU ) of a tertiary care hospital with 27 beds . Patients : 101 patients with > 3 days of mechanical ventilation and > 5 days of stay , without infection at the start of the study . 47 belonged to the Treated Group ( TG ) and 54 to the Placebo Group ( PG ) . Interventions : The TG was given Cefotaxime i.v . ( 6 g/day ) for the first four days and an association of Polymyxin E , Tobramycin and Amphothericin B at the oropharyngeal and gastrointestinal level throughout the whole stay . Results : In the TG , colonization by gram-negative agents at oropharyngeal , tracheal and gastrointestinal level fell significantly . There was a significant drop in the overall , respiratory and urinary NI ( 26 % vs 63%,p<0.001 ; 15 % vs 46%,p<0.001 ; 9 % vs 31%,p<0.01 ) . The overall mortality and NI related mortality was less in the TG ( 21 % vs 44%,p<0.05 ; 2 % vs 20%,p<0.01 ) . The economic costs , mechanical ventilation time and length of stay were similar . The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG ( 38 % vs 15 % and 38 % vs 9%,p<0.001 ) . Conclusions : colonization by gram-negative bacilli , NI and the mortality related to it can be modified by SDD . Continuous bacteriological surveillance is necessary 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 . Purpose Patients requiring mechanical ventilation ( MV ) for > 48 h after major heart surgery ( MHS ) are at a high risk of acquiring ventilator-associated pneumonia ( VAP ) and tracheobronchitis ( VAT ) . Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented . The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population . Methods We performed a prospect i ve r and omized open-label study of MHS patients requiring MV for > 48 h. Patients were r and omly allocated to one of two groups : the intervention group , which received a 3-day course of linezolid and meropenem , and the control group , which received the st and ard of care . The main outcome was the development of VAP or VAT . Results Overall , of the 78 patients included in the study , 40 were in the intervention group and 38 in the control group . Both groups were comparable . Data for the intervention and control groups respectively were as follows : VAP + VAT/1,000 days was 31.79 vs 64.78 ( p = 0.03 ) , median length of MV before the first episode of VAP or VAT 9 vs 4.5 days ( p = 0.02 ) . No significant differences were observed in median length of stay in the intensive care unit , median length of hospital stay , antibiotic use , Clostridium difficile infection , and overall mortality rate . We detected linezolid-resistant coagulase-negative and coagulase-positive staphylococci in the MHS intensive care unit after the study period . Conclusions A pre-emptive approach with broad-spectrum antibiotics may be effective in reducing the incidence and delaying the onset of VAP + VAT after MHS . The ecological consequences have to be carefully evaluated in future trials A double blind , placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination . Placebo or tobramycin ( 80 mg ) and colistin ( 100 mg ) was given four times daily via the gastric tube . Amphotericin B ( 500 mg/6h ) was administered to all patients . As our ICU is divided into two separate subunits , intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods , separated by a 2-month period without prevention . The  decontamination ( n=97 ) and placebo groups ( n=84 ) were similar with respect to age , sex , severity score and diagnostic categories on admission . Intestinal decontamination alone failed to significantly reduce the number of infected patients ( 26 % vs 34.5%,P=0.20 ) , but was effective on ICU-acquired infections ( 0.33 vs 0.60,p=0.02 ) especially gram-negative infection rates ( 0.17 vs 043,p=0.01 ) . The onset of the first ICU-acquired infection was delayed ( 9 vs 13 days , p<0.001 ) and incidence of pneumonia ( 2 vs 13 cases , p<0.01 ) including bacterial pneumonia ( 0 vs 8 cases , p<0.01 ) was significantly decreased . However , mean ICU stay and mortality were not significatly modified by intestinal decontamination We prospect ively evaluated the relation of upper airway , lower airway , and gastric colonization patterns with the development of pneumonia and its etiology in 48 patients with surgical ( n = 25 ) and medical ( n = 23 ) head injury . Initial colonization was assessed by  cultures of nasal and pharyngeal swabs , tracheobronchial aspirates , gastric juice , and bronchoscopically retrieved protected specimen brush .  Follow-up colonization was determined until the end points extubation , suspected ventilator-associated pneumonia ( VAP ) , or death . The initial colonization rate at any site at ICU admission was 39/47 ( 83 % ) . It mainly accounted for Group I pathogens ( Streptococcus pneumoniae , Staphylococcus aureus , Hemophilus influenzae ) of the upper and lower airways . At follow-up , colonization rates with Group II pathogens ( Gram-negative enteric bacilli and Pseudomonas spp . ) increased significantly . The high initial bacterial load with Group I pathogens of the upper airways and trachea decreased during Days 2 to 4 , whereas that of Group II pathogens increased . Upper airway colonization was an independent predictor of follow-up tracheobronchial colonization ( odds ratio [ OR ] , 9.9 ; 95 % confidence interval [ CI ] , 1.8 to 56.3 for initial colonization with Group I pathogens ; OR , 23.9 ; 95 % CI , 3.8 to 153.3 for follow-up colonization with Group II pathogens ) . Previous ( short-term ) antibiotics had a protective effect against colonization with Group I pathogens of the lower respiratory tract ( OR , 0.2 ; 95 % CI , 0.05 to 0.86 ) , but they were a risk factor for colonization with Group II pathogens ( OR , 6.1 ; 95 % CI , 1.3 to 29 ) . Initial tracheobronchial colonization with Group I pathogens was associated with a higher probability of early onset pneumonia ( OR , 4 . 1 ; 95 % CI , 0.7 to 23.3 ) , whereas prolonged antibiotic treatment ( > 24 h ) independently predicted late-onset pneumonia ( OR , 9.2 ; 95 % CI , 1.7 to 51.3 ) . We conclude that patients with head injury are colonized in the airways mainly by Group I pathogens early in the evolution of illness . The upper airways represent the main reservoir for subsequent lower airway colonization with Group I pathogens . Previous ( short-term ) antibiotic treatment is protective against initial tracheobronchial colonization with Group I pathogens , but it represents a risk factor for subsequent lower airway colonization by Group II pathogens Objective To study whether selective decontamination of the digestive tract ( SDD ) results in detectable serum tobramycin concentrations in intensive care unit ( ICU ) patients with acute renal failure treated with continuous venovenous hemofiltration ( CVVH ) 
    Output:
    
Selective digestive decontamination with systemic antimicrobial therapy reduced mortality and should be considered in critically ill patients at high risk for death