***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: 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 . Endotracheal administration of gentamicin has been compared with saline injections in a double-blind study of 85 patients admitted to a neurosurgical unit with tracheostomy . Endotracheal administration of gentamicin reduced significantly the incidence of colonization of the tracheal secretions by Gram-negative rods ( BACKGROUND This clinical trial evaluated the pharmacokinetics and safety/tolerability of amikacin/fosfomycin solution using a vibrating plate nebulizer , in mechanically ventilated patients with ventilator-associated tracheobronchitis ( VAT ) or ventilator-associated pneumonia ( VAP ) . METHODS Nine adult patients were consented to receive three escalating doses of a combination of 50 mg/mL amikacin and 20 mg/mL fosfomycin ; doses were separated by 24±2 hr . On day 3 , patients received two blinded , r and omized treatments ( amikacin/fosfomycin and volume-matched placebo ) , separated by 2 hr . All treatments were administered with a single-patient , multitreatment nebulizer ( Investigational eFlow ( ® ) Inline Nebulizer System ; PARI Pharma GmbH , positioned in the inspiratory limb tubing between the ventilator and the patient . The nebulizer remained in-line until all treatments had been delivered . Concentrations of amikacin and fosfomycin were measured in tracheal aspirate and plasma sample s obtained during the 24 hr after each dose . RESULTS Fifteen minutes after dosing with the 300/120 mg amikacin/fosfomycin combination , tracheal aspirate amikacin concentrations±SD were 12,390±3,986 μg/g , and fosfomycin concentrations were 6,174±2,548 μg/g ( n=6 ) . Airway clearance was rapid . Plasma concentrations were subtherapeutic ; the highest observed amikacin plasma concentration was 1.4 μg/mL , and the highest observed fosfomycin plasma concentration was 0.8 μg/mL. Administration time was approximately 2 min/mL. No adverse effects on respiratory rate , peak airway pressures , or oxygenation were observed during or following drug or placebo administration . CONCLUSIONS High tracheal aspirate concentrations of amikacin and fosfomycin were achieved in mechanically ventilated patients with VAT or VAP after aerosolized administration with an inline nebulizer system . Airway clearance was rapid . No adverse respiratory effects were noted during or following drug administration RATIONALE Subglottic secretion drainage ( SSD ) appears to be effective in preventing ventilator-associated pneumonia ( VAP ) , primarily by reducing early-onset pneumonia ; but it may not prevent late-onset pneumonia . We tested the hypothesis using an endotracheal tube incorporating an ultrathin polyurethane cuff ( which reduces channel formation and fluid leakage from the subglottic area ) , in addition to an SSD lumen , which would reduce the incidence of late-onset VAP . OBJECTIVES To compare the incidence of VAP , using an endotracheal tube with polyurethane cuff and subglottic secretion drainage ( ETT-PUC-SSD ) versus a conventional endotracheal tube ( ETT-C ) with polyvinyl cuff , without subglottic secretion drainage . METHODS Clinical r and omized trial in a 24-bed medical-surgical intensive care unit . Patients expected to require mechanical ventilation for more than 24 hours were r and omly assigned to one of two groups : one was ventilated with ETT-PUC-SSD and the other with ETT-C. MEASUREMENTS AND MAIN RESULTS Tracheal aspirate sample s were obtained during endotracheal intubation , then twice per week and finally on extubation . VAP was found in 31 of 140 ( 22.1 % ) patients in the ETT-C group and in 11 of 140 ( 7.9 % ) in the ETT-PUC-SSD group ( P = 0.001 ) . Cox regression analysis showed ETT-C as a risk factor for global VAP ( hazard ratio [ HR ] , 3.3 ; 95 % confidence interval [ CI ] , 1.66 - 6.67 ; P = 0.001 ) , early-onset VAP ( HR , 3.3 ; 95 % CI , 1.19 - 9.09 ; P = 0.02 ) , and late-onset VAP ( HR , 3.5 ; 95 % CI , 1.34 - 9.01 ; P = 0.01 ) . CONCLUSIONS The use of an endotracheal tube with polyurethane cuff and subglottic secretion drainage helps prevent early- and late-onset VAP . Clinical trial registered with www . clinical trials.gov ( NCT 00475579 ) STUDY OBJECTIVES To evaluate the safety and efficacy of aerosolized ceftazidime for prevention of  ventilator-associated pneumonia ( VAP )  and to evaluate the effects of the drug on the proinflammatory response . DESIGN Prospect i ve , r and omized , double-blind , placebo-controlled clinical trial . SETTING University teaching hospital . PATIENTS Forty critically ill trauma patients at high risk for VAP Intervention . Within 48 hours of admission to the intensive care unit ( ICU ) , patients were r and omly assigned to receive aerosolized ceftazidime 250 mg every 12 hours or placebo ( normal saline ) for up to 7 days . Bronchoalveolar concentrations of tumor necrosis factor-alpha ( TNF-alpha ) , interleukin (IL)-1beta , IL-6 , and IL-8 were determined at baseline and the end of therapy ( days 4 - 7 ) . MEASUREMENTS AND MAIN RESULTS The frequency of VAP in patients receiving aerosolized ceftazidime was 73 % lower than that in patients receiving placebo at ICU day 14 ( 15 % vs 55 % , p = 0.021 ) , and 54 % lower for the entire ICU stay ( 30 % vs 65 % , p = 0.022 ) . No clinical ly significant changes in bacterial culture and sensitivity patterns were observed . No adverse events from aerosolized ceftazidime were reported . Pulmonary TNF-alpha , IL-beta , and IL-8 concentrations were attenuated in the ceftazidime group compared with those in the placebo group ( p < 0.001 , p = 0.02 , and p = 0.003 ) . The frequency of VAP was related directly to changes in TNF-alpha and IL-beta ( p < 0.001 , p = 0.02 ) . CONCLUSIONS Aerosolized ceftazidime decreased the frequency of VAP in critically ill trauma patients , without adversely affecting ICU flora . Aerosolized ceftazidime also may attenuate the proinflammatory response in the lung We evaluated whether prophylactic nebulised colistin could reduce  ventilator-associated pneumonia ( VAP ) rates in an intensive care unit ( ICU ) setting with prevalent multidrug-resistant ( MDR ) bacteria . We used a single-centre , two-arm , r and omised , open-label , controlled trial in a 12-bed ICU in the University Hospital of Larissa , Greece . Patient inclusion criteria included mechanical ventilation of > 48 h. The two arms consisted of prophylaxis with 500 000 U colistin ( Col group ) or normal saline ( NS group ) , thrice daily , for the first 10 ICU days or until extubation . The primary outcome of the study was the 30-day VAP incidence .  In total , 168 patients entered the study .  VAP incidence was not different between Col and NS group patients ( 14 ( 16.7 % ) versus 25 ( 29.8 % ) , respectively , p=0.07 ) . Regarding the secondary outcomes , the intervention result ed in a lower VAP incidence density rate ( 11.4 versus 25.6 , respectively , p<0.01 ) , and less Gram-negative bacteria-VAP ( p=0.03 ) and MDR-VAP ( p=0.04 ) . Among  VAP patients ( n=39 ) , prophylaxis with inhaled colistin improved ICU survival ( p=0.016 ) . There was no evidence of increased resistance to colistin or multidrug resistance . Our findings suggest that nebulised colistin had no significant effect on VAP incidence . In a RCT , nebulised colistin prophylaxis did not decrease ventilator-associated pneumonia incidence Objective To evaluate the efficiency of intratracheal colistin in preventing nosocomial bronchopneumonia ( BPN ) in the critically ill . Design Study evaluating the clinical incidence of nosocomial BPN in 2 groups of critically ill patients who receive or did not receive intratracheal colistin .  BPN was assessed clinical ly in survivors and histologically in nonsurvivors . Setting A 14-bed surgical intensive care unit . Patients 598 consecutive critically ill patients were studied during a prospect i ve non-r and omized study over a 40-month period . Interventions 251 patients — 31 non-survivors and 220 survivors — did not receive intratracheal colistin  and 347 — 42 non-survivors and 305 survivors —  received intratracheal colistin for a 2-week period ( 16000000 units per 24h ) . Measurements and results The incidence of nosocomial BPN was evaluated clinical ly in survivors , using repeated protected minibronchoalveolar lavages , and histologically in non-survivors via an immediate postmortem pneumonectomy ( histologic and semi-quantitative bacteriologic analysis of one lung ) . The clinical incidence of nosocomial BPN was of 37 % in coli ( − ) survivors and of 27 % in coli ( + ) survivors ( p<0.01 ) . This result was histologically confirmed in non-survivors , where the incidence of histologic BPN was of 61 % in coli ( − ) patients and of 36 % in coli ( + ) patients ( p<0.001 ) . Emergence of BPN due to colistin-resistant micro-organisms was not observed . Because colistin was successful in preventing Gram-negative BPN and did not change the absolute number of Gram-positive BPN , the proportion of BPN caused bystaphylococcus species was higher in group coli ( + ) patients ( 33 % vs 16 % ) . Mortality was not significantly influenced by the administration of colistin . Conclusion This study suggests that the administration of intratracheal colistin during a 2-week period significantly reduces the incidence of Gram-negative BPN without creating an increasing number of BPN due to colistin-resistant micro-organism BACKGROUND Ventilator-associated pneumonia ( VAP ) is a frequent complication during recovery of severely traumatized patients . The primary objective of 
    Output:
    
Highlights : Prophylactic antibiotics administered via the respiratory tract reduce the occurrence of ventilator‐associated pneumonia .
This prophylactic strategy did n't have significant effect on ICU mortality