Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial
The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown. To determine associations between CHX 2%, SOD, and SDD and t...
Uloženo v:
| Vydáno v: | JAMA : the journal of the American Medical Association Ročník 320; číslo 20; s. 2087 |
|---|---|
| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
27.11.2018
|
| Témata: | |
| ISSN: | 1538-3598, 1538-3598 |
| On-line přístup: | Zjistit podrobnosti o přístupu |
| Tagy: |
Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
|
| Abstract | The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown.
To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance.
Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.
Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily.
The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period.
A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline.
Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.
ClinicalTrials.gov Identifier: NCT02208154. |
|---|---|
| AbstractList | The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown.ImportanceThe effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown.To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance.ObjectiveTo determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance.Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.Design, Setting, and ParticipantsRandomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily.InterventionsStandard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily.The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period.Main Outcomes and MeasuresThe occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period.A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline.ResultsA total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline.Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.Conclusions and RelevanceAmong patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.ClinicalTrials.gov Identifier: NCT02208154.Trial RegistrationClinicalTrials.gov Identifier: NCT02208154. The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown. To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance. Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017. Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily. The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period. A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline. Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care. ClinicalTrials.gov Identifier: NCT02208154. |
| Author | Depuydt, Pieter Leleu, Kris van den Abeele, Anne-Marie Vergara Gomez, Andrea Sifrer, Franc Coll, Pere Damas, Pierre Wise, Matt P Malhotra-Kumar, Surbhi Meex, Cécile Nardi, Giuseppe Mancebo, Jordi Tomic, Viktorija Fernández Méndez, Sara Verbrugghe, Walter Boelens, Jerina Jorens, Philippe G Sperning, Roberta H M Gomes Pimenta de Matos, Ana Filipa Dugernier, Thierry Verbelen, Valérie Lopez-Contreras, Joaquin Villarreal Tello, Esther Coppadoro, Patrizia Santos, Claudia Brun-Buisson, Christian Cooper, Ben S Aragao, Irene Ruiz Ramos, Jesus Morgan, Matt P G Bonten, Marc J M Wittekamp, Bastiaan H Plantinga, Nienke L |
| Author_xml | – sequence: 1 givenname: Bastiaan H surname: Wittekamp fullname: Wittekamp, Bastiaan H organization: Intensive Care Center and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands – sequence: 2 givenname: Nienke L surname: Plantinga fullname: Plantinga, Nienke L organization: Medical Microbiology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands – sequence: 3 givenname: Ben S surname: Cooper fullname: Cooper, Ben S organization: Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England – sequence: 4 givenname: Joaquin surname: Lopez-Contreras fullname: Lopez-Contreras, Joaquin organization: Infectious Diseases-Internal Medicine, Hospital de Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain – sequence: 5 givenname: Pere surname: Coll fullname: Coll, Pere organization: Department of Microbiology, Hospital de Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain – sequence: 6 givenname: Jordi surname: Mancebo fullname: Mancebo, Jordi organization: Department of Intensive Care, Hospital de Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain – sequence: 7 givenname: Matt P surname: Wise fullname: Wise, Matt P organization: Adult Critical Care, University Hospital of Wales, Cardiff, Wales – sequence: 8 givenname: Matt P G surname: Morgan fullname: Morgan, Matt P G organization: Adult Critical Care, University Hospital of Wales, Cardiff, Wales – sequence: 9 givenname: Pieter surname: Depuydt fullname: Depuydt, Pieter organization: Intensive Care, Ghent University Hospital, Ghent, Belgium – sequence: 10 givenname: Jerina surname: Boelens fullname: Boelens, Jerina organization: Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium – sequence: 11 givenname: Thierry surname: Dugernier fullname: Dugernier, Thierry organization: Department of Intensive Care Medicine, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium – sequence: 12 givenname: Valérie surname: Verbelen fullname: Verbelen, Valérie organization: Microbiology Department, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium – sequence: 13 givenname: Philippe G surname: Jorens fullname: Jorens, Philippe G organization: IntensiveCare Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium – sequence: 14 givenname: Walter surname: Verbrugghe fullname: Verbrugghe, Walter organization: IntensiveCare Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium – sequence: 15 givenname: Surbhi surname: Malhotra-Kumar fullname: Malhotra-Kumar, Surbhi organization: Laboratory of Medical Microbiology, Vaccine, & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium – sequence: 16 givenname: Pierre surname: Damas fullname: Damas, Pierre organization: Department of Intensive Care Medicine, CHU Liège, Liege, Belgium – sequence: 17 givenname: Cécile surname: Meex fullname: Meex, Cécile organization: Clinical Microbiology, CHU Liège, Liege, Belgium – sequence: 18 givenname: Kris surname: Leleu fullname: Leleu, Kris organization: Anesthesiology and Critical Care, AZ Sint Jan Bruges, Bruges, Belgium – sequence: 19 givenname: Anne-Marie surname: van den Abeele fullname: van den Abeele, Anne-Marie organization: Microbiology Laboratory, Saint-Lucas Hospital Ghent, Ghent, Belgium – sequence: 20 givenname: Ana Filipa surname: Gomes Pimenta de Matos fullname: Gomes Pimenta de Matos, Ana Filipa organization: Serviço de Medicina Intensiva, Centro Hospitalar de Trás-os-Montes os Montes e Alto Douro, Vila Real, Portugal – sequence: 21 givenname: Sara surname: Fernández Méndez fullname: Fernández Méndez, Sara organization: Medical Intensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain – sequence: 22 givenname: Andrea surname: Vergara Gomez fullname: Vergara Gomez, Andrea organization: Microbiology Department, Hospital Clinic of Barcelona, Barcelona, Spain – sequence: 23 givenname: Viktorija surname: Tomic fullname: Tomic, Viktorija organization: Laboratory for Respiratory Microbiology, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia – sequence: 24 givenname: Franc surname: Sifrer fullname: Sifrer, Franc organization: Intensive Care Unit, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia – sequence: 25 givenname: Esther surname: Villarreal Tello fullname: Villarreal Tello, Esther organization: Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain – sequence: 26 givenname: Jesus surname: Ruiz Ramos fullname: Ruiz Ramos, Jesus organization: Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain – sequence: 27 givenname: Irene surname: Aragao fullname: Aragao, Irene organization: Intensive Care (UCIP), Hospital Santo Antonio-Centro Hospitalar do Porto (CHP), Porto, Portugal – sequence: 28 givenname: Claudia surname: Santos fullname: Santos, Claudia organization: Microbiology Laboratory, Hospital Santo Antonio-Centro Hospitalar do Porto (CHP), Porto, Portugal – sequence: 29 givenname: Roberta H M surname: Sperning fullname: Sperning, Roberta H M organization: Department of Microbiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy – sequence: 30 givenname: Patrizia surname: Coppadoro fullname: Coppadoro, Patrizia organization: Intensive Care Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy – sequence: 31 givenname: Giuseppe surname: Nardi fullname: Nardi, Giuseppe organization: Department of Anesthesia and Intensive Care, Ospedale Infermi RIMINI-AUSL della Romagna, Rimini, Italy – sequence: 32 givenname: Christian surname: Brun-Buisson fullname: Brun-Buisson, Christian organization: Medical Intensive Care and Infection Control Unit, CHU Henri Mondor & University Paris Est Créteil, Paris, France – sequence: 33 givenname: Marc J M surname: Bonten fullname: Bonten, Marc J M organization: Medical Microbiology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30347072$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkD1PxDAMhiME4ntmQxlZeiRN2qZsx_F1EggEB4wnt_GBUZtAkxvgZ_CLCQIkvNiv9eix5C226rxDxvakGEkh5OEL9DDKhTQjqaqyWGGbslAmU0VtVv_NG2wrhBeRKmHrbEMJpStR5Zvs8wRb7yL05CCSd_wuDhDxiTBwcJYfd97bEAeEnk_dAttvKPBHis987CI15CO12S0GChFc5FfUDt4PT-Ao9IGT4w-YuC5JLb9JN1IKR3zMb5Pe9_SR1pOOHLXQ8dlA0O2wtQV0AXd_-za7PzudTS6yy-vz6WR8mYHWKmZWYVsabRZS11WpmrrEwrYGjJAFGIX1QheyEoigygp10ygLtSirGnQD2tp8mx38eF8H_7bEEOc9hRa7Dhz6ZZjnUplS6boUCd3_RZdNj3b-OlAPw_v874_5F_I8ej4 |
| CitedBy_id | crossref_primary_10_1186_s40635_022_00429_8 crossref_primary_10_1089_sur_2022_420 crossref_primary_10_1007_s00134_019_05882_w crossref_primary_10_1093_cid_ciz554 crossref_primary_10_1186_s13063_022_06407_5 crossref_primary_10_1016_j_iccn_2022_103196 crossref_primary_10_1136_bmj_2021_065871 crossref_primary_10_1016_j_iccn_2022_103227 crossref_primary_10_1016_j_cmi_2019_05_004 crossref_primary_10_1007_s00134_020_06276_z crossref_primary_10_1186_s13054_018_2227_2 crossref_primary_10_1016_j_accpm_2021_100987 crossref_primary_10_1016_j_arbres_2020_01_015 crossref_primary_10_4187_respcare_11961 crossref_primary_10_1016_j_jceh_2025_102600 crossref_primary_10_1002_jac5_1402 crossref_primary_10_1093_ofid_ofz288 crossref_primary_10_1177_1756284820939447 crossref_primary_10_1007_s12325_020_01458_z crossref_primary_10_1007_s00134_022_06649_6 crossref_primary_10_1007_s00134_020_05980_0 crossref_primary_10_1055_a_1950_6657 crossref_primary_10_1186_s13054_020_03219_4 crossref_primary_10_3389_fcimb_2025_1569748 crossref_primary_10_1016_j_idc_2021_08_001 crossref_primary_10_1001_jama_2019_0444 crossref_primary_10_1016_j_cmi_2021_02_025 crossref_primary_10_1001_jama_2019_0448 crossref_primary_10_1136_bmj_m3800 crossref_primary_10_1007_s00134_020_05950_6 crossref_primary_10_1097_CCM_0000000000004047 crossref_primary_10_3390_antibiotics13040316 crossref_primary_10_1093_jac_dkaa305 crossref_primary_10_1186_s13063_023_07356_3 crossref_primary_10_1186_s40560_025_00786_y crossref_primary_10_1080_23744235_2020_1754457 crossref_primary_10_1093_jac_dkaf033 crossref_primary_10_1007_s10096_019_03596_x crossref_primary_10_1017_ice_2019_303 crossref_primary_10_1007_s00134_024_07500_w crossref_primary_10_1200_OP_25_00314 crossref_primary_10_1007_s10096_021_04234_1 crossref_primary_10_1056_NEJMc2001183 crossref_primary_10_1093_jac_dky573 crossref_primary_10_1007_s00134_022_06826_7 crossref_primary_10_1093_jac_dkz300 crossref_primary_10_1080_14656566_2023_2213828 crossref_primary_10_1186_s13054_025_05309_7 crossref_primary_10_1007_s10096_023_04573_1 crossref_primary_10_1007_s00134_024_07360_4 crossref_primary_10_1093_cid_ciaa1585 crossref_primary_10_1186_s13054_019_2460_3 crossref_primary_10_1136_bmjopen_2018_028876 crossref_primary_10_1186_s13054_019_2480_z crossref_primary_10_1080_14737159_2025_2458467 crossref_primary_10_1016_j_medin_2023_05_009 crossref_primary_10_1093_jac_dkaa495 crossref_primary_10_1186_s13613_021_00976_5 crossref_primary_10_1016_j_idnow_2023_104666 crossref_primary_10_1007_s00134_023_07115_7 crossref_primary_10_1007_s00134_021_06359_5 crossref_primary_10_1007_s00134_019_05883_9 crossref_primary_10_1089_sur_2023_020 crossref_primary_10_1097_CCM_0000000000005708 crossref_primary_10_1111_nicc_12940 crossref_primary_10_1007_s10096_023_04581_1 crossref_primary_10_1055_s_0042_1749448 crossref_primary_10_1177_08850666221133318 crossref_primary_10_3390_jcm12041432 crossref_primary_10_3390_gidisord5020019 crossref_primary_10_1007_s00134_023_07289_0 crossref_primary_10_1136_bmjopen_2022_061838 crossref_primary_10_1001_jama_2019_0456 crossref_primary_10_1136_bmjopen_2022_064256 crossref_primary_10_1016_j_idc_2021_07_005 crossref_primary_10_1016_j_jhin_2022_02_019 crossref_primary_10_3390_antibiotics11020263 crossref_primary_10_3389_fcimb_2021_755545 crossref_primary_10_1016_j_cmi_2019_08_001 crossref_primary_10_1186_s40560_019_0372_6 crossref_primary_10_1001_jama_2022_18623 crossref_primary_10_1097_ACO_0000000000000734 crossref_primary_10_1001_jama_2022_17927 crossref_primary_10_1016_j_cmicom_2025_105078 crossref_primary_10_1016_j_bjao_2025_100425 crossref_primary_10_1001_jama_2022_19709 crossref_primary_10_1016_j_jcrc_2021_05_001 crossref_primary_10_1001_jama_2019_0452 crossref_primary_10_1097_PTS_0000000000000743 crossref_primary_10_1001_jama_2023_0215 crossref_primary_10_1016_j_imj_2024_100142 crossref_primary_10_1038_s41572_021_00259_0 crossref_primary_10_1016_j_medine_2023_05_018 crossref_primary_10_1080_19490976_2024_2351478 crossref_primary_10_1097_MCP_0000000000000559 crossref_primary_10_1097_MOG_0000000000000781 crossref_primary_10_1093_jac_dkac408 crossref_primary_10_1007_s10096_024_04792_0 crossref_primary_10_1128_aac_01574_24 crossref_primary_10_3389_fphar_2022_903378 crossref_primary_10_3390_antibiotics13030281 crossref_primary_10_1177_0885066620985538 crossref_primary_10_1097_CCM_0000000000004000 crossref_primary_10_3390_sym13061027 crossref_primary_10_3390_antibiotics13111096 crossref_primary_10_1016_j_jhin_2025_05_021 crossref_primary_10_1186_s12882_023_03442_5 crossref_primary_10_1016_j_jinf_2019_02_007 crossref_primary_10_1136_gutjnl_2024_331955 crossref_primary_10_1186_s13054_021_03744_w crossref_primary_10_1371_journal_pone_0325241 crossref_primary_10_1016_j_rmed_2025_108275 crossref_primary_10_1097_QCO_0000000000000596 crossref_primary_10_1017_ice_2022_88 crossref_primary_10_1093_jac_dky530 crossref_primary_10_1186_s13613_022_01014_8 crossref_primary_10_1186_s13613_022_01057_x crossref_primary_10_1097_CCM_0000000000004237 crossref_primary_10_1038_s41467_022_34101_2 crossref_primary_10_1016_j_idc_2020_08_003 crossref_primary_10_1186_s13613_023_01159_0 crossref_primary_10_1097_CCE_0000000000000076 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jama.2018.13765 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1538-3598 |
| ExternalDocumentID | 30347072 |
| Genre | Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Journal Article |
| GrantInformation_xml | – fundername: Medical Research Council grantid: MR/R004536/1 |
| GroupedDBID | --- -ET -~X .55 .XZ 0R~ 0WA 186 18M 29J 2CT 2FS 2KS 2WC 354 39C 4.4 53G 5GY 5RE 6TJ 85S AAIKC AAMNW AAQOH AAQQT AAWTL ABBLC ABCQX ABEHJ ABIVO ABOCM ABPMR ABPPZ ABRSH ABWJO ACAHW ACGFS ACNCT ACPRK ADBBV ADUKH ADXHL AETEA AFCHL AFFNX AFRAH AGHSJ AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU ARBJA BKOMP BRYMA C45 CGR CJ0 CS3 CUY CVF EAM EBD EBS ECM EIF EJD EMOBN EX3 F5P H13 HF~ KOO KQ8 L7B MVM N4W N9A NEJ NPM OBH OCB OGEVE OHH OMK OVD P2P PQQKQ QJJ RAJ RNS S10 SJN SV3 TEORI TN5 UHB UKR UPT VVN WH7 WOW X7M XHN XSW XZL YFH YOC YPV YQT YQY YR2 YR5 YSK YYM YZZ ZCA ~H1 7X8 |
| ID | FETCH-LOGICAL-a443t-d3ec6848f149763b96e5dc8a8015a83e9f45170eea367e4bb3da90679a4ba4dd2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 129 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000451395000016&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1538-3598 |
| IngestDate | Mon Jul 21 10:56:58 EDT 2025 Mon Jul 21 06:08:11 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 20 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a443t-d3ec6848f149763b96e5dc8a8015a83e9f45170eea367e4bb3da90679a4ba4dd2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| PMID | 30347072 |
| PQID | 2138634960 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2138634960 pubmed_primary_30347072 |
| PublicationCentury | 2000 |
| PublicationDate | 2018-11-27 |
| PublicationDateYYYYMMDD | 2018-11-27 |
| PublicationDate_xml | – month: 11 year: 2018 text: 2018-11-27 day: 27 |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA : the journal of the American Medical Association |
| PublicationTitleAlternate | JAMA |
| PublicationYear | 2018 |
| References | 30964520 - JAMA. 2019 Apr 9;321(14):1409-1410. doi: 10.1001/jama.2019.0444. 30964522 - JAMA. 2019 Apr 9;321(14):1408-1409. doi: 10.1001/jama.2019.0452. 30964521 - JAMA. 2019 Apr 9;321(14):1409. doi: 10.1001/jama.2019.0448. 30347049 - JAMA. 2018 Nov 27;320(20):2081-2083. doi: 10.1001/jama.2018.13764. |
| References_xml | – reference: 30964520 - JAMA. 2019 Apr 9;321(14):1409-1410. doi: 10.1001/jama.2019.0444. – reference: 30964522 - JAMA. 2019 Apr 9;321(14):1408-1409. doi: 10.1001/jama.2019.0452. – reference: 30347049 - JAMA. 2018 Nov 27;320(20):2081-2083. doi: 10.1001/jama.2018.13764. – reference: 30964521 - JAMA. 2019 Apr 9;321(14):1409. doi: 10.1001/jama.2019.0448. |
| SSID | ssj0000137 |
| Score | 2.6093743 |
| Snippet | The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 2087 |
| SubjectTerms | Adult Aged Aged, 80 and over Anti-Infective Agents - therapeutic use Bacteremia - prevention & control Chlorhexidine - therapeutic use Cross Infection - prevention & control Disinfection - methods Drug Resistance, Bacterial Female Gastrointestinal Tract - microbiology Gram-Negative Bacterial Infections - prevention & control Hospital Mortality Humans Intensive Care Units Male Middle Aged Mouthwashes - therapeutic use Oropharynx - microbiology Respiration, Artificial Young Adult |
| Title | Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/30347072 https://www.proquest.com/docview/2138634960 |
| Volume | 320 |
| WOSCitedRecordID | wos000451395000016&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8QwFA5uiBf3fSGC12g7SZvEi4wbCs4wiMvchnSS4MBMqqZ68Gf4i81rO-hFELz0UJpHSd6Wt3wPoYPUMEFtRIlMeUpYYiVRMktIpJUBc8JVCdf0cMPbbdHtyk4dcPN1WeVYJ5aKWud9iJEfNWIqUkA3j06eXwhMjYLsaj1CYxJN0-DKAFfzrvgBH1ViZpZCDUh1Y2ifb9ShWByGb9Lkd_-ytDOXC__9w0U0X3uYuFmxxBKaMG4ZzbbqHPoK-jyHO3ChoAYGTgWPAWqNx8ppfAql7NBCokb4ui7Vch4_Doon3HTQYpIHyuTWeHA9XYFbUNNXTYfyI48HDj9ACdIwENW4U-G2-mPcxLeBfD4afITXNRzpEN-BAKyi-8uLu7MrUk9mIIoxWhBNTT8VTNhwvwoKKpOpSXRfqGDuEiWokZYlMY-MUTTlhmUZ1UpCyEqxTDGtG2toyuXObCAclIpS0I9vmWGxtDJiNostFxrAIxnbRPvj3e4Fzod0hnImf_O97_3eROvVkfWeK4iOXjDMjEe8sfWH1dtoDhgBGgwbfAdN2yD3ZhfN9N-LgX_dK1kqPNud1hfDutiX |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Decontamination+Strategies+and+Bloodstream+Infections+With+Antibiotic-Resistant+Microorganisms+in+Ventilated+Patients%3A+A+Randomized+Clinical+Trial&rft.jtitle=JAMA+%3A+the+journal+of+the+American+Medical+Association&rft.au=Wittekamp%2C+Bastiaan+H&rft.au=Plantinga%2C+Nienke+L&rft.au=Cooper%2C+Ben+S&rft.au=Lopez-Contreras%2C+Joaquin&rft.date=2018-11-27&rft.eissn=1538-3598&rft.volume=320&rft.issue=20&rft.spage=2087&rft_id=info:doi/10.1001%2Fjama.2018.13765&rft_id=info%3Apmid%2F30347072&rft_id=info%3Apmid%2F30347072&rft.externalDocID=30347072 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1538-3598&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1538-3598&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1538-3598&client=summon |