Premises:
(1) Ventilator-associated pneumonia is an important cause of morbidity and mortality in the ICU.
(2) Ventilator-associated pneumonia often arises from aerobic bacteria in the mouth, oropharynx and upper GI tract.
(3) Preservation of the anaerobic bacteria in the gut will prevent complications of overgrowth by resistant organisms.
The regimen is started as soon as possible after admission to the ICU.
Standard regimen:
(1) oral delivery of topical, nonabsorbed antibiotics (polymyxin E and tobramycin) that target bacteria commonly associated with ventilator-associated pneumonia but sparing anaerobic bacteria
(2) oral delivery of a topical, nonabsorbable antifungal agent (amphotericin B) to suppress yeast
(3) intravenous cefotaxime sodium is given to prevent bacterial infection until surveillance cultures show adequate decontamination of the GI tract
(4) optimal hygiene to prevent exogenous infection
(5) surveillance cultures of rectum and respiratory tract to monitor the effectiveness of the decontamination and to detect emergence of resistant organism
The regimen is maintained until mechanical ventilation is discontinued or the patient is discharged from the ICU.
