Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study.
The efficacy of a relatively cheap regimen of selective decontamination (SDD) was evaluated in a diverse population of ICU patients. Patients requiring prolonged ICU stay (greater than 5 days) were randomly allocated to a treatment group or control group. Control patients (n = 52) received perioperative antimicrobial prophylaxis and antibiotic treatment was instituted only on sound clinical and bacteriological criteria. Treated patients (n = 48) received gastro-intestinal and oro-pharyngeal decontamination with polymyxin E, norfloxacin, amphotericin B and systemic antibiotic prophylaxis with trimethoprim until decontamination was achieved. The rate of gram-positive infections was not altered by SDD. The incidence of gram-negative respiratory tract, urinary tract and line infections was significantly reduced from 44%, 27% and 15% respectively in the control group to 6%, 4% and 0% in the treatment group. Mortality from nosocomial sepsis and overall mortality were also significantly reduced from 15% and 54% to 0% and 31% respectively. The ICU stay was not reduced by SDD, nor was time on the ventilator or use of therapeutic antibiotics. The reduction in morbidity and mortality was achieved at a relatively low cost.
Ulrich
C
C
Westeinde Hospital, Hague, The Netherlands.
Harinck-de Weerd
J E
JE
Bakker
N C
NC
Jacz
K
K
Doornbos
L
L
de Ridder
V A
VA
D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D004064:Digestive System; D005260:Female; D006090:Gram-Negative Bacteria; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009643:Norfloxacin / Q000592:standards / Q000627:therapeutic use*; D011292:Premedication; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012137:Respiratory System
D009643:Norfloxacin