Selective decontamination of the digestive tract reduces gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation.
OBJECTIVE
To examine the effect of selective antibiotic decontamination of the digestive tract in patients undergoing elective orthotopic liver transplantation.


METHODS
Prospective, randomized, concurrent allocation to either selective decontamination or standard antibiotic prophylaxis.


METHODS
Operating theater and intensive care unit at a tertiary referral, university teaching hospital.


METHODS
Fifty-nine adult patients were recruited into the study and underwent liver transplantation.


METHODS
Thirty-two patients were randomized to standard treatment (control group) and 27 patients were randomized to receive selective decontamination. After early deaths and exclusions, 31 controls and 21 decontamination patients were available for analysis.


RESULTS
Portal and systemic endotoxemia, colonization and infection rates, severity of illness (organ system failures, Acute Physiology and Chronic Health Evaluation II score, Therapeutic Intervention Scoring System score), antibiotic costs, and hospital survival rates were measured. Selective decontamination significantly reduced pulmonary infections and enteric, aerobic, and Gram-negative bacillary colonization without facilitating the emergence of resistant organisms, but selective decontamination had no effect on endotoxemia or the development of organ system failures. The financial costs of the selective decontamination regimen outweighed the advantages gained from an associated reduction in antibiotic usage.


CONCLUSIONS
The failure of selective decontamination to enhance survival rates in many studies of the regimen in critically ill patients may, in part, be related to the inability of selective decontamination to abolish endotoxemia.
Bion
J F
JF
Department of Intensive Care, Queen Elizabeth Hospital, Birmingham, UK.
Badger
I
I
Crosby
H A
HA
Hutchings
P
P
Kong
K L
KL
Baker
J
J
Hutton
P
P
McMaster
P
P
Buckels
J A
JA
Elliott
T S
TS
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care; D004066:Digestive System Diseases / Q000382:microbiology* / Q000503:physiopathology / Q000517:prevention & control*; D004731:Endotoxins / Q000097:blood; D005243:Feces / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D016031:Liver Transplantation; D008171:Lung Diseases / Q000382:microbiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology* / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D004731:Endotoxins