163 特 集 SDD & SOD SDD(Selective digestive decontamination),sod(selective oropharynx decontamination), 腸内細菌叢, 耐性菌 Ⅰ はじめに SDD Selective digestive decontamination SOD Selective oropharynx decontamination VAP ventilator associated pneumonia bacterial translocation Selective SDD SOD SDD SOD 606 8507 54 Ⅱ SDD & SOD の目的, 方法 Selective SDD SOD VAP ventilator associated pneumonia bacterial translocation Ⅲ SDD & SOD の臨床研究 SDD 1984 Stoutenbeek 1 5 ICU 122
164 SDD & SOD SDD 59 63 E100 mg 80 mg B500 mg 2 E 2 B 48 /59 81 SDD SOD 10 /63 16 RCT RCT 1992 Gastinne 15 ICU 445 SDD 220 225 60 2 E100 mg 80 mg B 100 mg 2 E 2 B 60 SDD 75 34 67 30 SDD 33 15 26 12 SDD 2.2 RCT 1992 Hammond 5 ICU 48 ICU 239 SDD 114 125 3 E100 mg 80 mg B 500 mg 2 E 2 B 1g 1 3 SDD 21 18 21 17 SDD 30 26 43 34 ICU SDD 16.2 16.8 SDD 2003 de Jonge 3 ICU 48 ICU 934 SDD 466 468 4 B 500 mg 2 E 2 2 B 1g 1 4 ICU SDD 69 15 107 23 SDD 113 24 146 31 SDD ICU SDD 61 /378 16 104 /395 26 SDD 2002 Krueger ICU 2 ICU 527 SDD 265 262 5 B 50 mg 80 mg 125 mg 400 mg 1 2 ICU5 24 SDD 9 9 28 SDD 28 11 51 19 SDD APACHE II 20 29 SDD 6 2 29 11 SDD 14 5 36 14 Ⅳ Cochrane Collaboration によるメタ解析 Stoutenbeek
165 SDD & SOD ICU RCT Cochrane Collaboration SDD SOD 6 2009 62 RCTs 36 RCTs 6914 17 RCTs 14 RCTs 5RCTs 33RCTs 5697 19 40 20 31 36RCTs 24 30 26 25 SDD Ⅴ SDD & SOD の最近のガイドラインの推奨度 2009 de Smet 13 ICU RCT 3 ICU 48 ICU 5939 SDD 2045 SOD 1904 1990 28 SDD 546 26.9 SOD 502 26.6 544 27.5 1 SDD 0.83 95 CI 0.72 0.97 SOD 0.86 95 CI 0.74 0.99 SDD SOD 7 RCT SDD SOD SDD SOD 2008 SSCG Surviving Sepsis Campaign Guideline SDD SOD 2012 SSCG SOD SDD VAP 2013 SDD SOD 2012 SSCG Sepsis registry SDD SOD 3 Ⅵ SDD,SOD を使用することで耐性菌の増加は有るのか Lingnau SDD 17.0 vs 80.7 vs SDD 25 vs 67 vs SDD 8 2006 Naiemi SDD ESBL 9 2010 Oostdijk
166 SDD & SOD 13 ICU 7 vs 13 vs SDD 10 2013 Daneman SDD & SOD 64 SDD & SOD 35 RCT Systematic review 11 MRSA 1.46 95 CI 0.9 2.37 VRE 0.63 95 CI 0.51 1.05 SDD SDD 0.73 95 CI 0.51 1.05 0.52 95 CI 0.16 1.68 0.33 95 CI 0.2 0.52 3 0.33 95 CI 0.2 0.52 SDD Systematic review ICU 2014 Oostdijk 16 ICU SOD 5881 SDD 6116 12 28 SOD 25.4 SDD 24.1 SOD 11.8 SDD 5.6 SOD 12.7 SDD 7.3 ESBL SOD 7.7 SDD 4.4 SOD 10.3 SDD 5.6 SOD SOD 5.9 SDD 4.6 SOD SDD SOD SDD SOD Ⅶ SDD,SOD の限界と腸内細菌叢是正の可能性 SDD ICU MRSA VRE ESBL SDD SOD 2005 de La Cal 20 107 SDD 53 54 13 ICU SDD 5 9.4 15 27.8 SDD 17 / 1000 30.8 / 1000 SDD ICU SDD SOD
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