Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study.
OBJECTIVE
To evaluate the effect of a method of Selective Decontamination of the Digestive Tract (SDD) on colonization, nosocomial infection (NI), bacterial resistance, mortality and economic costs.


METHODS
Randomized, double blind, placebo controlled study.


METHODS
Polyvalent intensive care unit (ICU) of a tertiary care hospital with 27 beds.


METHODS
101 patients with > 3 days of mechanical ventilation and > 5 days of stay, without infection at the start of the study. 47 belonged to the Treated Group (TG) and 54 to the Placebo Group (PG).


METHODS
The TG was given Cefotaxime i.v. (6 g/day) for the first four days and an association of Polymyxin E, Tobramycin and Amphotericin B at the oropharyngeal and gastrointestinal level throughout the whole stay.


RESULTS
In the TG, colonization by gram-negative agents at oropharyngeal, tracheal and gastrointestinal level fell significantly. There was a significant drop in the overall, respiratory and urinary NI (26% vs 63%, p < 0.001; 15% vs 46%, p < 0.001; 9% vs 31%, p < 0.01). The overall mortality and NI related mortality was less in the TG (21% vs 44%, p < 0.05; 2% vs 20%, p < 0.01). The economic costs, mechanical ventilation time and length of stay were similar. The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG (38% vs 15% and 38% vs 9%, p < 0.001).


CONCLUSIONS
colonization by gram-negative bacilli, NI and the mortality related to it can be modified by SDD. Continuous bacteriological surveillance is necessary.
Rocha
L A
LA
Department of Intensive Care Unit, Juan Canalejo Hospital, La Coruña, Spain.
Martín
M J
MJ
Pita
S
S
Paz
J
J
Seco
C
C
Margusino
L
L
Villanueva
R
R
Durán
M T
MT
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004064:Digestive System / Q000382:microbiology*; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D015600:Glasgow Coma Scale; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
D000900:Anti-Bacterial Agents