***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: Objective : To evaluate silver-impregnated ( Oligon ) central venous catheters and chlorhexidine – gluconate-impregnated sponges for reducing catheter-related colonization and infection , nonbacteremic or bacteremic . Design : Multicenter , prospect i ve , r and omized , controlled study . Setting : Five general intensive care units in Greece . Patients : Intensive care unit patients requiring a multilumen central venous catheter between June 2006 and May 2008 . Interventions : Patients were r and omly assigned to receive a st and ard catheter ( st and ard group ) , a st and ard catheter plus chlorhexidine – gluconate-impregnated sponge ( chlorhexidine – gluconate-impregnated sponge group ) , or an Oligon catheter ( Oligon group ) . Catheter colonization was defined as a positive quantitative tip culture ( ≥103 colony-forming units/mL ) , catheter-related infection was defined by the previous criterion plus clinical evidence of sepsis , and bacteremia catheter-related infection as catheter-related infection plus a positive peripheral blood culture with the same micro-organism as in the catheter tip . Measurements and Main Results : Data were obtained from 465 patients , 156 in the st and ard-group , 150 in the chlorhexidine – gluconate-impregnated sponge group , and 159 in the Oligon-group . Colonization occurred in 24 ( 15.4 % ) st and ard catheters , 21 ( 14 % ) in the chlorhexidine – gluconate-impregnated sponge group , and 25 ( 15.7 % ) in the Oligon catheters ( p = .35 ) ( 20.9 , 19.9 , 21.8/1000 catheter-days , respectively ) . Catheter-related infections were recorded in nine ( 5.8 % ) st and ard catheters , six ( 4 % ) in the chlorhexidine – gluconate-impregnated sponge group , and seven ( 4.4 % ) in the Oligon catheters ( p = .58 ) ( 7.8/1,000 , 5.7/1,000 , 6.1/1,000 catheter-days , respectively ) . No difference was observed between the chlorhexidine– gluconate-impregnated sponge group and the st and ard group regarding catheter colonization ( hazard ratio 1.21 ; 95 % confidence interval 0.56–2.61 ; p = .64 ) and catheter-related infections ( hazard ratio 0.65 ; 95 % confidence interval 0.23–1.85 ; p = .42 ) . The Oligon catheter did not reduce colonization or catheter-related infections when compared with the st and ard catheter ( colonization : hazard ratio 1.0 ; 95 % confidence interval 0.46–2.21 ; p = .98 ; catheter-related infection : hazard ratio 0.72 ; 95 % confidence interval 0.27–1.95 ; p = .52 ) . Seven patients ( 1.5 % , 2.09/1,000 catheter-days ) presented bacteremic catheter-related infections . Central venous catheters inserted either in the internal jugular or the femoral vein had greater risk to be colonized than catheters inserted in the subclavian vein ( internal jugular vs. subclavian : hazard ratio 3.29 ; 95 % confidence interval 1.26–8.61 ; p = .01 ; femoral vs. subclavian : hazard ratio 3.36 ; 95 % confidence interval 1.17–9.65 ; p = .02 ) . Acinetobacter baumannii was the predominant pathogen ( 37.1 % episodes of colonization , 36.4 % catheter-related infections , 57.1 % bacteremic catheter-related infections ) . Conclusion : For short-term ( median duration 7 days ) central venous catheters in intensive care units with high prevalence of multiresistant Gram-negative bacteria , chlorhexidine-impregnated sponges and Oligon catheters as single preventive measures did not reduce catheter colonization or catheter-related infections . As a result of the limited amount of events , no conclusion could be reached regarding bacteremic catheter-related infections . The femoral site was the most frequently colonized insertion site in all types of catheters Objective : To document the effect of gingival and dental plaque antiseptic decontamination on the rate of  nosocomial bacteremias and respiratory infections acquired in the intensive care unit ( ICU ) . Design : Prospect i ve , multicenter , double-blind , placebo-controlled efficacy study . Setting : Six ICUs : three in university hospitals and three in general hospitals . Patients : A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation , with an anticipated length of stay ≥5 days . Interventions : Antiseptic decontamination of gingival and dental plaque with a 0.2 % chlorhexidine gel or a placebo gel , three times a day , during the entire ICU stay . Measurements and Main Results : Demographic and clinical characteristics , organ function data ( Logistic Organ Dysfunction score ) , severity of condition ( Simplified Acute Physiologic Score ) , and dental plaque status were assessed at baseline and until 28 days . Bacteriologic sampling of dental plaque and saliva was done every 5 days , and blood , tracheal aspirate , and bronchoalveolar lavage cultures were performed when appropriate . The primary efficacy end point was the incidence of bacteremia , bronchitis , and ventilator-associated pneumonia , expressed as a percentage and per 1000 ICU days . All baseline characteristics were similar between the treated and the placebo groups . The incidence of nosocomial infections was 17.5 % ( 13.2 per 1000 ICU days ) in the placebo group and 18.4 % ( 13.3 per 1000 ICU days ) in the plaque antiseptic decontamination group ( not significant ) . No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days , mortality , length of stay , and care loads ( secondary end points ) . On day 10 , the number of positive dental plaque cultures was significantly lower in the treated group ( 29 % vs. 66 % ; p < .05 ) . Highly resistant Pseudomonas , Acinetobacter , and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination . No side effect was reported . Conclusions : Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients . However , its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria 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 . BACKGROUND Infectious complications and associated mortality are a major concern in acute pancreatitis . Enteral administration of probiotics could prevent infectious complications , but convincing evidence is scarce . Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis . METHODS In this multicenter r and omized , double-blind , placebo-controlled trial , 298 patients with predicted severe acute pancreatitis ( Acute Physiology and Chronic Health Evaluation [ APACHE II ] score ≥8 , Imrie score ≥3 , or C-reactive protein > 150 mg/L ) were r and omly assigned within 72 h of onset of symptoms to receive a multispecies probiotic preparation ( n = 153 ) or placebo ( n = 145 ) , administered enterally twice daily for 28 days . The primary endpoint was the composite of infectious complications-i.e . , infected pancreatic necrosis , bacteremia , pneumonia , urosepsis , or infected ascites-during admission and 90-day follow-up . Analyses were by intention to treat . This study is registered , number IS RCT N38327949 . FINDINGS One person in each group was excluded from analyses because of incorrect diagnoses of pancreatitis ; thus , 152 individuals in the probiotics group and 144 in the placebo group were analysed . Groups were much the same at baseline in terms of patients ' characteristics and disease severity . Infectious complications occurred in 46 ( 30 % ) patients in the probiotics group and 41 ( 28 % ) of those in the placebo group ( relative risk 1.06 , 95 % CI 0.75 - 1.51 ) . 24 ( 16 % ) patients in the probiotics group died , compared with nine ( 6 % ) in the placebo group ( relative risk 2.53 , 95 % CI 1.22 - 5.25 ) . Nine patients in the probiotics group developed bowel ischaemia ( eight with fatal outcome ) , compared with none in the placebo group ( p = 0.004 ) . INTERPRETATION In patients with predicted severe acute pancreatitis , probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality  . Probiotic prophylaxis should therefore not be administered in this category of patients . ( Lancet . 2008;371(9613):651 - 659 ) MGH Besselink , HC van Santvoort , E Buskens , et al , for the Dutch Acute Pancreatitis Study Group Introduction Preventing carriage of potentially pathogenic micro-organisms from the aerodigestive tract is an infection control strategy used to reduce the occurrence of ventilator-associated pneumonia  in intensive care units . However , antibiotic use in selective decontamination protocol s is controversial . The purpose of this study was to investigate the effect of oral administration of a probiotic , namely Lactobacillus , on  gastric and respiratory tract colonization/infection with Pseudomonas aeruginosa strains . Our hypothesis was that an indigenous flora should exhibit a protective effect against secondary colonization . Methods We conducted a prospect i ve , r and omized , double-blind , placebo-controlled pilot study between March 2003 and October 2004 in a 17-bed intensive care unit of a teaching hospital in Clermont-Ferr and , France . Consecutive patients with a unit stay of longer than 48 hours were included , 106 in the placebo group and 102 in the probiotic group .  Through a nasogastric feeding tube , patients received either 109 colony-forming units unity forming colony of Lactobacillus casei rhamnosus or placebo twice daily , from the third day after admission to discharge . Digestive tract carriage of P. aeruginosa was monitored by cultures of gastric asp 
    Output:
    
We identified a significant reduction in MDR-GNB colonisation and infection through the use of patient-level interventions .
This effect was mostly accounted for by selective digestive decontamination .