Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient
There are several antiseptic, antibiotic and non-decontamination-based interventions for preventing intensive care unit (ICU) acquired infection. These have been evaluated in >200 studies. Infection prevention using topical antibiotic prophylaxis (TAP) appears to be the most effective. Whether an...
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| Format: | Article |
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MDPI AG
2021-06-01
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| Series: | Symmetry |
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| Online Access: | https://www.mdpi.com/2073-8994/13/6/1027 |
| _version_ | 1797531019171069952 |
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| author | James C. Hurley |
| author_facet | James C. Hurley |
| author_sort | James C. Hurley |
| collection | DOAJ |
| description | There are several antiseptic, antibiotic and non-decontamination-based interventions for preventing intensive care unit (ICU) acquired infection. These have been evaluated in >200 studies. Infection prevention using topical antibiotic prophylaxis (TAP) appears to be the most effective. Whether antibiotic use in the ICU may influence the risk of infection among concurrent control patients within the same ICU and result in asymmetrical herd effects cannot be resolved with individual studies examined in isolation. The collective observations within control and intervention groups from numerous ICU infection prevention studies simulates a multi-center natural experiment enabling the herd effects of antibiotics to be evaluated. Among the TAP control groups, the incidences for both ventilator associated pneumonia (VAP) and mortality are unusually high in comparison to literature-derived benchmarks. Paradoxically, amongst the TAP intervention groups, the incidences of mortality are also unusually high and the VAP incidences are similar (i.e., not lower) compared to the incidences among studies of other interventions. By contrast, the mortality incidences among the intervention groups of other studies are similar to those among the intervention groups of TAP studies. Using topical antibiotics to prevent infections acquired within the ICU environment may result in profoundly asymmetrical effects. |
| first_indexed | 2024-03-10T10:37:13Z |
| format | Article |
| id | doaj.art-810d6216b8dc4cadbc2e6dec6264c130 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-10T10:37:13Z |
| publishDate | 2021-06-01 |
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| spelling | doaj.art-810d6216b8dc4cadbc2e6dec6264c1302023-11-21T23:12:43ZengMDPI AGSymmetry2073-89942021-06-01136102710.3390/sym13061027Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU PatientJames C. Hurley0Department of Rural Health, Melbourne Medical School, University of Melbourne, Ballarat 3350, AustraliaThere are several antiseptic, antibiotic and non-decontamination-based interventions for preventing intensive care unit (ICU) acquired infection. These have been evaluated in >200 studies. Infection prevention using topical antibiotic prophylaxis (TAP) appears to be the most effective. Whether antibiotic use in the ICU may influence the risk of infection among concurrent control patients within the same ICU and result in asymmetrical herd effects cannot be resolved with individual studies examined in isolation. The collective observations within control and intervention groups from numerous ICU infection prevention studies simulates a multi-center natural experiment enabling the herd effects of antibiotics to be evaluated. Among the TAP control groups, the incidences for both ventilator associated pneumonia (VAP) and mortality are unusually high in comparison to literature-derived benchmarks. Paradoxically, amongst the TAP intervention groups, the incidences of mortality are also unusually high and the VAP incidences are similar (i.e., not lower) compared to the incidences among studies of other interventions. By contrast, the mortality incidences among the intervention groups of other studies are similar to those among the intervention groups of TAP studies. Using topical antibiotics to prevent infections acquired within the ICU environment may result in profoundly asymmetrical effects.https://www.mdpi.com/2073-8994/13/6/1027bacteremiatopical antibiotic prophylaxisstudy designintensive caremechanical ventilationselective digestive decontamination |
| spellingShingle | James C. Hurley Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient Symmetry bacteremia topical antibiotic prophylaxis study design intensive care mechanical ventilation selective digestive decontamination |
| title | Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient |
| title_full | Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient |
| title_fullStr | Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient |
| title_full_unstemmed | Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient |
| title_short | Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient |
| title_sort | asymmetric effects of decontamination using topical antibiotics for the icu patient |
| topic | bacteremia topical antibiotic prophylaxis study design intensive care mechanical ventilation selective digestive decontamination |
| url | https://www.mdpi.com/2073-8994/13/6/1027 |
| work_keys_str_mv | AT jameschurley asymmetriceffectsofdecontaminationusingtopicalantibioticsfortheicupatient |