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92. Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients : a randomized clinical trialBastiaan H. Wittekamp, Nienke L. Plantinga, Ben S. Cooper, Joaquin Lopez-Contreras, Pere Coll, Jordi Mancebo, Matt P. Wise, Matt P. G. Morgan, Pieter Depuydt, Jerina Boelens, Viktorija Tomič, Franc Šifrer, 2018, original scientific article Abstract: Importance: 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. Objective: 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. Design, setting, and participants: 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 [beta]-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. Interventions: 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. Main outcomes and measures: 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. Results: 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. Conclusions and relevance: 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. Keywords: anti-infective agents -- therapeutic use, bacteremia -- prevention and control, chlorhexidine -- therapeutic use, cross infection -- prevention and control, disinfection -- methods, bacterial drug resistance, gastrointestinal tract -- microbiology, Gram-negative bacterial infections -- prevention and control, hospital mortality, intensive care units, mouthwashes -- therapeutic use, oropharynx -- microbiology, artificial respiration, multicenter study, randomized controlled trial Published in DiRROS: 09.11.2020; Views: 1345; Downloads: 456
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93. Rak trebušne slinavke : kaj morate vedeti o bolezni?Janja Ocvirk, Martina Reberšek, Zvezdana Hlebanja, Erik Škof, Irena Oblak, Vaneja Velenik, Franc Anderluh, 2008, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, simptomi, diagnostika, zdravljenje, bolečina Published in DiRROS: 10.08.2020; Views: 1877; Downloads: 727
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94. Rak požiralnika : kaj morate vedeti o bolezni?Franc Anderluh, Irena Oblak, Vaneja Velenik, Janja Ocvirk, Zvezdana Hlebanja, Martina Reberšek, Mihael Sok, 2008, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, simptomi, diagnostika Published in DiRROS: 10.08.2020; Views: 1842; Downloads: 584
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96. Rak želodca : kaj morate vedeti o bolezni?Franc Anderluh, Andrej Marušič, Irena Oblak, Janja Ocvirk, Martina Reberšek, Erik Škof, Vaneja Velenik, 2006, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, simptomi, diagnostika, zdravljenje Published in DiRROS: 10.06.2020; Views: 1786; Downloads: 481
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97. 30 let spremljanja stanja gozdov v SlovenijiGregor Božič, Matjaž Čater, Mitja Ferlan, Maarten De Groot, Tine Hauptman, Domen Finžgar, Katarina Flajšman, Anže Japelj, Dušan Jurc, Milan Kobal, Marko Kovač, Hojka Kraigher, Lado Kutnar, Tom Levanič, Aleksander Marinšek, Nikica Ogris, Matej Rupel, Primož Simončič, Iztok Sinjur, Mitja Skudnik, Mihej Urbančič, Andrej Verlič, Urša Vilhar, Saša Vochl, Marjana Westergren, Daniel Žlindra, 2015, scientific monograph Keywords: gozdarstvo, monitoring gozdov, zborniki, Slovenija Published in DiRROS: 05.06.2020; Views: 2317; Downloads: 618
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98. Rak požiralnika : kaj morate vedeti o bolezniMarko Boc, Martina Reberšek, Janja Ocvirk, Jernej Benedik, Zvezdana Hlebanja, Neva Volk, Maja Ebert Moltara, Tanja Mesti, Franc Anderluh, Vaneja Velenik, Irena Oblak, Jasna But-Hadžić, Ajra Šečerov Ermenc, Nada Rotovnik-Kozjek, Matevž Srpčič, 2014, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, simptomi, diagnostika, zdravljenje, paliativna oskrba, prehrana Published in DiRROS: 04.06.2020; Views: 1926; Downloads: 546
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99. Rak trebušne slinavke : kaj morate vedeti o bolezniMartina Reberšek, Marko Boc, Irena Oblak, Jernej Benedik, Zvezdana Hlebanja, Janja Ocvirk, Neva Volk, Tanja Mesti, Maja Ebert Moltara, Tomaž Milanez, Franc Anderluh, Vaneja Velenik, Jasna But-Hadžić, Ajra Šečerov Ermenc, Ana Jeromen, Nada Rotovnik-Kozjek, Katja Kogovšek, Aleš Tomažič, 2014, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, bolniki, simptomi, diagnostika, zdravljenje, bolečina, dietna terapija, paliativna oskrba Published in DiRROS: 04.06.2020; Views: 2286; Downloads: 699
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100. Smernice za zdravljenje bolnikov z rakom požiralnika in ezofagogastričnega stika (EGS)2016, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: rak požiralnika, rak ezofagogastritičnega stika, smernice, zdravljenje Published in DiRROS: 27.05.2020; Views: 2095; Downloads: 627
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