Mortality in this study is low. This is partly explained by the design of the study: the fact that only patients with a duration of mechanical ventilation exceeding four days were included eliminates early mortality. Even taking this into account, mortality in the control groups still seems low considering the high incidence of LRTI. This […]

Intubation and sedation are the principal factors in aspiration of oropharyngeal and gastric contents, because they interfere with the normal clearing mechanisms of the trachea. It should be stressed that the tube cuff does not protect against microaspiration: small quantities of oropharyngeal secretion frequently pass the cuff, especially if high-volume cuffed tubes are used.

The design of our study does not permit determination of whether the reduced colonization and infection rates were caused by topical antibiotics, parenteral cefotaxime, or the combination of the two. However, the prevention of microbial colonization of oropharynx and stomach in group 3 patients lasted long after parenteral cefotaxime therapy was discontinued, and seems to […]

However, the effect of cefotaxime, polymyxin E, and norfloxacin on the protective anaerobic flora had not been well studied in man at the start of our investigation. It has been shown recently that cefotaxime does disturb the protective indigenous flora in man. Nevertheless, our regimen proved effective, probably because colonization and infection with resistant Gram-negative […]

Although there is some controversy, most authors agree that these early LRTIs cannot be prevented solely by topical administration of antibiotics to oropharynx and stomach. Therefore five days of intravenous cefotaxime (1 g four times a day) was added to the regimen. However, since a lower dose of cefotaxime achieves serum and sputum levels exceeding […]

Antibiotic Use Tiie reduction of the respiratory tract infection rate in group 3 resulted in a reduction of the use of systemic antibiotic therapy. The number of patients requiring antibiotic therapy was 17 (94 percent) in group 1, 21 (100 percent) in group 2, but only 11 (65 percent) in group 3. The mean number […]

After the first five days of hospital admission, newly acquired microorganisms became increasingly important in the pathogenesis of LRTI. In these late infections, Cram-negative bacilli prevailed, causing 74 percent of the infections; Gram-positive cocci (13 percent) and H influenzae (8 percent) were less important.