Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit.
To evaluate the use of selective decontamination of the digestive tract (SDD) (polymyxin, amphotericin, tobramycin, and intravenous cefotaxime) in a mixed intensive care unit, we performed a stratified, randomized, prospective study. The 331 patients were recruited over an 18-month period, with 256 patients remaining more than 48 hours. Stratification by acute physiology and chronic health evaluation (APACHE II) preceded randomization to control (standard antibiotic therapy) or treatment (SDD) groups. Nosocomial infection was significantly reduced in the SDD group (16.7%; 21 of 126 patients) compared with the control group (30.8%; 40 of 130 patients; p = 0.008). No difference was found in overall mortality rate or length of stay between the two groups. Those patients with admission APACHE II scores 10 to 19 demonstrated the most significant reduction in nosocomial infection (23 of 70 control vs 13 of 76 SDD; p = 0.03) and mortality (15 of 70 control vs 8 of 76 SDD; p = 0.07). Emergence of multiresistant microorganisms was not a clinical problem, but a definite change occurred in the ecology of environmental and colonizing bacteria. With the exception of cefotaxime, a reduction was noted in systemic antibiotic usage in the SDD group. We conclude that SDD is useful in selected patients in a mixed intensive care unit.
Blair
P
P
Department of Surgery, Queen's University of Belfast, Northern Ireland.
Rowlands
B J
BJ
Lowry
K
K
Webb
H
H
Armstrong
P
P
Smilie
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D002439:Cefotaxime / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D003428:Cross Infection / Q000517:prevention & control; D004064:Digestive System / Q000187:drug effects* / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011113:Polymyxins / Q000627:therapeutic use; D011446:Prospective Studies; D014031:Tobramycin / Q000627:therapeutic use
D011113:Polymyxins; D000666:Amphotericin B; D002439:Cefotaxime; D014031:Tobramycin