Utility of selective digestive decontamination in mechanically ventilated patients.
OBJECTIVE
To assess selective digestive decontamination for preventing nosocomial pneumonia and mortality in mechanically ventilated patients.


METHODS
Prospective, randomized, placebo-controlled, double-blind study.


METHODS
Respiratory intensive care unit of a 1000-bed teaching hospital.


METHODS
80 patients receiving mechanical ventilation for more than 72 hours.


METHODS
Patients received selective digestive decontamination using polymyxin E, tobramycin, and amphotericin B through a nasogastric tube and also topically in the oropharynx; control patients received placebo. All patients received intravenous cefotaxime for 4 days or other systemic antibiotics if required.


METHODS
Bacteriologic surveillance (three times a week) was done by quantitatively culturing tracheal aspirates, pharyngeal swabs, and gastric juice. The diagnosis of pneumonia was based on quantitative cultures of protected specimen brush samples (> or = 10(3) CFU/mL [colony forming units/mL]) or bronchoalveolar lavage fluid (> or = 10(4) CFU/mL) and autopsy findings.


RESULTS
Bronchial, oropharyngeal, and gastric colonization by gram-negative bacilli and Candida species was lower in the selective digestive decontamination group compared with the placebo group. Nonsignificant differences were found in the incidence of nosocomial infections (28% compared with 37%; odds ratio, 0.66; 95% CI, 0.35 to 1.25) and nosocomial pneumonia (18% compared with 24%; odds ratio, 0.7; CI, 0.33 to 1.46) and in the crude mortality rate (31% compared with 27%; odds ratio, 1.21; CI, 0.63 to 2.34) when comparing digestive decontamination with placebo, respectively.


CONCLUSIONS
Selective digestive decontamination in our mechanically ventilated patients significantly decreased the colonization rate of gram-negative bacilli and of Candida species but not of Staphylococcus aureus. It did not decrease the incidence of nosocomial pneumonia, mortality, length of stay, or the duration of mechanical ventilation.
Ferrer
M
M
Hospital Clínic, Universitat de Barcelona, Spain.
Torres
A
A
González
J
J
Puig de la Bellacasa
J
J
el-Ebiary
M
M
Roca
M
M
Gatell
J M
JM
Rodriguez-Roisin
R
R
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002177:Candidiasis / Q000517:prevention & control; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D004064:Digestive System / Q000382:microbiology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004866:Equipment Contamination; D006090:Gram-Negative Bacteria / Q000254:growth & development; D016905:Gram-Negative Bacterial Infections / Q000517:prevention & control; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D013030:Spain; D013997:Time Factors
D000900:Anti-Bacterial Agents