***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: 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 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 To assess risk factors for development of c and idal blood stream infections ( CBSIs )  , a prospect i ve cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit ( SICU ) for > 48 h over a 2-year period . Among 4276 such patients , 42 CBSIs occurred ( 9.82 CBSIs per 1000 admissions ) . The overall incidence was 0.98 CBSIs per 1000 patient days and 1.42 per 1000 SICU days with a central venous catheter in place . In multivariate analysis , factors independently associated with increased risk of CBSI included prior surgery ( relative risk [ RR ] , 7.3 ) , acute renal failure ( RR , 4.2 ) , receipt of parenteral nutrition ( RR , 3.6 ) , and , for patients who had undergone surgery , presence of a triple lumen catheter ( RR , 5.4 ) . Receipt of an antifungal agent was associated with decreased risk ( RR , 0.3 ) . Prospect i ve clinical studies are needed to identify which antifungal agents are most protective and which high-risk patients will benefit from antifungal prophylaxis 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 Abstract Objective To examine the extent and nature of outcome reporting bias in a broad cohort of published r and omised trials . Design Retrospective review of publications and follow up survey of authors . Cohort All journal articles of r and omised trials indexed in PubMed whose primary publication appeared in December 2000 . Main outcome measures Prevalence of incompletely reported outcomes per trial ; reasons for not reporting outcomes ; association between completeness of reporting and statistical significance . Results 519 trials with 553 publications and 10 557 outcomes were identified . Survey responders ( response rate 69 % ) provided information on unreported outcomes but were often unreliable — for 32 % of those who denied the existence of such outcomes there was evidence to the contrary in their publications . On average , over 20 % of the outcomes measured in a parallel group trial were incompletely reported . Within a trial , such outcomes had a higher odds of being statistically non-significant compared with fully reported outcomes ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.7 ) for efficacy outcomes ; 1.9 ( 1.1 to 3.5 ) for harm outcomes ) . The most commonly reported reasons for omitting efficacy outcomes included space constraints , lack of clinical importance , and lack of statistical significance . Conclusions Incomplete reporting of outcomes within published articles of r and omised trials is common and is associated with statistical non- significance . The medical literature therefore represents a selective and biased subset of study outcomes , and trial protocol s should be made publicly available OBJECTIVE To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients . DESIGN R and omized , controlled trial without blinding . SETTING Surgical trauma and medical intensive care units in a tertiary referral hospital . PATIENTS One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval , whose condition suggested a prolonged stay ( greater than 3 days ) . INTERVENTION Patients were r and omly allocated to an experimental group ( n = 75 ) that received cefotaxime , 1 g intravenously every 8 hours for the first 3 days only , and oral , nonabsorbable antibiotics ( gentamicin , polymyxin , and nystatin by oral paste and oral liquid ) for the entire stay in the intensive care unit . Control patients ( n = 75 ) received usual care . MEASUREMENTS The number of infections , total hospital days , and deaths , as well as the number of days in intensive care unit , were recorded . RESULTS Control patients experienced more infections ( 36 compared with 12 , P = 0.04 ) , including bacteremias ( 14 compared with 4 , P = 0.05 ) and pulmonary infections ( 14 compared with 4 , P = 0.03 ) . Although total hospital days , days in intensive care , and the overall death rate all were lower in the treatment group , these differences were not statistically significant . Clinical ly important complications of selective decontamination of the digestive tract were not encountered . CONCLUSIONS Selective decontamination of the digestive tract decreases subsequent infection rates , especially by gram-negative bacilli , in selected patients during long-term stays in the intensive care unit 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 Summary All ICU patients were continuously monitored for infections according to a st and ard protocol by the physician in charge and an infection control nurse during the first quarter of five consecutive years ( 1980–1984 ) . The number of patients surveyed was 1,009 . The average age was 45.5 years and the average period of stay about four days . 733 patients ( 72.6 % ) were intubated and artificially ventilated for three days . A fatal outcome result ed in 13.2 % of all patients . 1,129 nosocomial infections were registered in 331 patients , which means an infection rate of 32.8 % . The most frequent nosocomial infections were those of the respiratory tract ( 24.3 % ) . Wound infections developed in 16.6 % . The urinary tract was affected in 8.8 % . Nosocomial septicaemias were observed in 8.7 % . Catheter-associated infections were found in 6.7 % of the patients . A fatal outcome result ed in 26 % of the patients with nosocomial infections and in 6.9 % of the non-infected patients , respectively . There was no significant reduction in nosocomial infections over the five-year period in our ICU . Therefore , a study was design ed to evaluate the concept of selective decontamination of the digestive tract ( SDD ) in critically ill patients in our two surgical/traumatological ICUs . A prospect i ve , consecutive , placebo-controlled study in two ICUs was carried out during four six-month periods . 200 patients who were intubated for at least three days , required intensive care for a minimum of five days , and belonged to either class III or IV according to the “ Therapeutic Intervention Scoring System ” were included in the study . They received either placebo or a prophylaxis regimen , consisting of polymyxin E , tobramycin and amphotericin B. The rates of nosocomial bronchopulmonary infections ( ICU I and II ) and urinary tract infections ( ICU II ) were significantly reduced . There was no significant reduction in wound infection , septicaemia and mortality rates . Selective flora suppression is effective in reducing infection rates in critically ill patients without development of resistant strains . ZusammenfassungZur Dokumentation nosokomialer Infektionen auf einer Intensivstation wurden in einer täglichen gemeinsamen Infektionsvisite von Untersucher und H 
    Output:
    
Effectiveness of prophylaxis reduced with an increased proportion of included surgical patients .
Conclusion Antifungal prophylaxis ( SAP or SDD ) is effective in reducing yeast colonisation and infections across a range of critically ill patients .
Indirect comparisons suggest that SDD is more effective in reducing yeast-related outcomes , except for c and idemia