Utilisation des antibiotiques pour la prevention des pneumonies bacteriennes dans les Unites de soins intensifs chirurgicaux. [Use of antibiotics for the prevention of bacterial pneumonia in surgical intensive care units]

Bacterial pneumonia is responsible for high mortality in surgical intensive care patients which is partly attributable to a high incidence of gram-negative bacillary pneumonia. In these patients alterations to epithelial cell surfaces promote colonization of the oropharynx by gram-negative bacilli. The alterations are directly related to the severity of the patients' underlying disease and not to the hospital environment. Prospective studies on prophylactic administration of antibiotics to decrease the incidence of nosocomial pneumonia are reviewed. In these studies antibiotic have been administered either locally in the respiratory tract or systemically by the i.v. route. In both cases a moderate decrease in the incidence of pneumonia was observed, but selection of resistant bacteria occurred. Pneumonia appearing despite antibiotic prophylaxis was difficult to treat and had a high mortality. Therefore, local or intravenous antibiotic administration for routine prophylaxis of pneumonia seems to do more harm than good in patients from intensive care units