***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 Selective decontamination of the oropharynx and gastrointestinal tract with nonabsorbable antimicrobials and sucralfate , a stress ulcer prophylactic that maintains the normal gastric acid bacterial barrier , were compared for prevention of pneumonia in a cardiac surgery intensive care unit . Over 8 months , 51 patients received selective decontamination and 56 received sucralfate .  The selective decontamination regimen included polymyxin , gentamicin , and nystatin given as an oral paste and as a solution ; patients also received st and ard antacid or histamine2 blocker stress ulcer prophylaxis . Patients in the selective decontamination group had significantly less colonization of the oropharynx and stomach by gram-negative bacilli ( 12 % vs. 55 % , P less than .001 ) , significantly fewer infections due to gram-negative bacilli ( 6 % vs. 20 % , P = .02 ) , and fewer infections overall ( 12 % vs. 27 % , P = .04 ) . There was one episode of pneumonia in the selective decontamination group and five in the sucralfate group . Mortality and length of stay did not differ between the groups , but those receiving selective decontamination had less than one-third as many days of systemic antibiotic therapy with no increase in colonization or infection with resistant gram-negative bacilli . Thus , selective decontamination appeared to reduce both extrapulmonary and pulmonary infections BACKGROUND Reduction of potential pathogens by selective intestinal decontamination has been proposed to improve intensive care . Despite large scientific interest in this method , little is known about its benefit in homogeneous trauma population s. METHODS In a prospect i ve , controlled study , we enrolled non-infected trauma patients ( age over 18 years , mechanical ventilation > or = 48 hours , intensive care for more than 3 days ) who primarily were admitted to our university medical center . We r and omized patients to be treated with two different topical regimens ( polymyxin , tobramycin , and amphotericin ( PTA ) or polymyxin , ciprofloxin , amphotericin ( PCA ) ) or the carrier only ( placebo ) , administered four times daily both to the oropharynx and to the gastrointestinal tract . All patients received intravenous ciprofloxacin ( 200 mg , bd ) for 4 days . FINDINGS Of 357 enrolled patients , 310 ( age 38.0 + /- 16.5 years , Injury Severity Score 35.2 + /- 12.7 ) met all inclusion criteria . Selective decontamination successfully reduced intestinal bacterial colonization . However , we did not identify significant differences between groups regarding pneumonia ( PTA 47.5 % , PCA 39.0 % , placebo 45.3 % ) , sepsis ( PTA 47.5 % , PCA 37.8 % , placebo 42.6 % ) , multiple organ failure ( PTA 56.3 % ; PCA 52.4 % , placebo 58.1 % ) , and death ( PTA 11.3 % , PCA 12.2 % , placebo 10.8 % ) . Total costs per patient were highest with the PTA regimen . CONCLUSIONS We found no benefit of selective decontamination in trauma patients . Apparently , bacterial overgrowth in the intestinal tract is not the sole link between trauma , sepsis , and organ failure STUDY OBJECTIVE To study the efficacy of intestinal decontamination by oral nonabsorbable antibiotic agents to control a nosocomial outbreak of intestinal colonization and infection with multiresistant Enterobacteriaceae , and to examine its effects on endemic nosocomial infection rates . DESIGN A 10-week prospect i ve incidence study ( group 1 ) , and then an 8-week r and omized , open trial of intestinal decontamination ( groups 2 and 3 ) . SETTING A medical intensive care unit of a tertiary care university hospital . PATIENTS Consecutive patients with unit stay of over 2 days and a severity score at admission of more than 2 ; 124 patients were included in group 1 , 50 in group 2 ( control ) , and 36 in group 3 ( intestinal decontamination ) . INTERVENTIONS Neomycin , polymyxin E , and nalidixic acid were given to group 3 patients throughout their stay in the unit . MEASUREMENTS AND MAIN RESULTS Intestinal colonization with multiresistant strains occurred in 19.6 % of patients in group 1 , at a mean of 16 days after admission , and preceded detection in clinical sample s by a mean of 11 days . During the decontamination trial , intestinal colonization rates decreased to 10 % ( group 2 ) , and 3 % ( group 3 ) ( P = 0.12 and P less than 0.01 , compared with group 1 , respectively ) . Corresponding infection rates were 9 % ( group 1 ) , 3 % ( group 2 ) , and 0 ( group 3 ) . No new cases were detected in the following 4 months . The intestinal colonization rate with gram-positive cocci was higher in group 3 than group 2 ( P less than 0.001 ) . The overall rate of nosocomial infections was at 28 % ( group 1 ) , 33 % ( group 2 ) , and 32 % ( group 3 ) . CONCLUSIONS Intestinal decontamination can help to control an outbreak of intestinal colonization and infection with multiresistant gram-negative bacilli in the intensive care unit , but should not be recommended for routine prevention of endemic nosocomial infections In a prospect i ve r and omized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections , 96 intensive care patients were r and omly allocated into a control group and a study group . The study group received oral nonabsorbable antimicrobial agents ( i.e. , tobramycin , amphotericin B , and polymyxin E ) in addition to parenteral antibiotics .  Colonization with Gram-negative microorganisms in the oropharynx , and respiratory and digestive tracts increased in the control group during their stay , while the study group did not tend to colonize with Gram-negative bacteria . In the control group , 107 nosocomial infections were diagnosed , vs. 42 nosocomial infections in the study group .  Nosocomial infections caused by Gram-negative bacteria were significantly less frequent in the study group . Mortality due to an acquired infection was significantly less frequent in the study group . We conclude that colonization , infection , and subsequent mortality by nosocomial Gram-negative bacteria can be prevented by a regime of topically applied nonabsorbable antibiotics Selective decontamination of the digestive tract ( SDD ) , by means of non-absorbable antibiotics , to prevent infection in intensive-care units ( ICUs ) remains controversial ; there is evidence that the regimen reduces the incidence of secondary infection , but no convincing reduction in morbidity or mortality has been shown and the costs and effect on microbial resistance patterns need further study . In a double-blind , placebo-controlled trial , we have tried to find out whether SDD should be used routinely in all ICU patients at high risk of secondary infection . All patients admitted to the ICU who were thought likely to stay in the unit for at least 5 days and to need intubation for longer than 48 h were enrolled and r and omly allocated to groups receiving placebo or SDD ( amphotericin , colistin , and tobramycin applied to the oropharynx and enterally ) ; all patients received intravenous cefotaxime for 72 h.  Of 322 patients r and omised , 83 were withdrawn ( 80 ICU stay or duration of intubation too short , 3 protocol violations ) . 239 medical , trauma , and surgical patients completed the trial period ( 114 SDD , 125 placebo ) . There were no differences between SDD and placebo groups in incidence of infection ( 30 [ 26 % ] vs 43 [ 34 % ] patients ; p = 0.22 ) , duration of ICU stay ( mean 16.2 [ 14.3 ] vs 16.8 [ 12.3 ] days ) , hospital stay ( 29.9 [ SD 25.0 ] vs 31.9 [ 22.2 ] days ) , or mortality ( 21 [ 18 % ] vs 21 [ 17 % ] ) . SDD substantially increased the costs of intensive care . Mechanisms other than bacterial colonisation of the gut may bring about substantial numbers of secondary infections in ICUs . Routine use of SDD in multidisciplinary ICUs can not be recommended A comparative , prospect i ve study was made of the incidence of infection in the lower airway ( purulent tracheobronchitis and pneumonia ) in long-term patients who were mechanically ventilated due to respiratory failure of noninfectious origin . Twenty-eight patients were r and omly allocated into a study group ( A , n = 13 ) in which a nonabsorbable paste containing 2 % tobramycin , 2 % amphotericin B , and 2 % polymyxin E was administered locally to decontaminate the oropharynx , and a control group ( B , n = 15 ) in which a paste without antibiotics was also applied to the oropharynx . We studied the effectiveness of the prophylactic technique in decontaminating the oropharynx and trachea of organisms potentially pathogenic for the respiratory system . Decontamination was successful in ten of 13 patients in group A vs. one of 15 patients in group B ( p less than .001 ) . The results demonstrated a lower rate of infection in the lower respiratory tract in the study group ( three patients with tracheobronchitis and no pneumonias ) than in the control group ( three patients with tracheobronchitis and 11 with pneumonia ) , the difference between both being highly significant ( p less than .001 ) . Two ( 15 % ) patients in group B developed sepsis of pulmonary origin . None of the patients on prophylactic treatment developed this complication . Although the overall mortality was similar in both groups ( group A , 30 % vs. group B , 33 % ) , we believe that infection contributed to a great extent to the death of two of five patients in group B. We conclude that nosocomial pneumonia , which is a frequent complication in critically ill patients on mechanical ventilation , could be prevented by local application of nonabsorbable antibiotics to the oropharynx Suppression of the gut luminal aerobic flora to reduce nosocomial infections was tested in a prospect i ve , r and omized , double-blind , placebo-controlled clinical trial in patients in a surgical intensive care unit who had persistent hypermetabolism . Forty-six patients were r and omized to receive either norfloxacin , 500-mg suspension every 8 hours , together with nystatin , 1 million units every 6 hours , or matching placebo solutions administered through a nasogastric tube within 48 hours of surgical intensive care unit admission . Selective gut decontamination with the experimental therapy or placebo solutions continued for at least 5 days or until the time of surgical intensive care unit discharge . Patients were monitored with routine surveillance cultures for the development of nosocomial infections , as defined by criteria from the Centers for Disease Control . All other therapy was given as clinical ly indicated , including systemic antibiotics . The selective gut decontamination group experienced a significant reduction in the incidence of nosocomial infections and a reduced length of stay . However , these results were not associated with a concomitant decrease in progressive multiple organ failure syndrome , adult respiratory distress syndrome , or mortality Nosocomial pneumonia is a frequent complication of prolonged mechanical ventilation [ 1 - 3 ] . Oropharyngeal and gastric colonization , 
    Output:
    
This meta- analysis of 15 years of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients .