Neurologic disease requiring long-term ventilation. The role of selective decontamination of the digestive tract in preventing nosocomial infection.
OBJECTIVE
To evaluate the efficacy of the technique of selective decontamination of the digestive tract (SDD) in preventing secondary infections in patients with neurologic diseases requiring intensive care.


METHODS
Randomized, double-blind, placebo-controlled trial using amphotericin B, polymyxin E, and tobramycin applied to the oropharynx and enterally; all patients received intravenous cefotaxime for 72 h.


METHODS
Respiratory ICU.


METHODS
Forty patients with neurologic diseases requiring ventilation for > 48 h and ICU stay > 5 days. Neurologic diagnosis included acute inflammatory demyelinating neuropathy (15), meningoencephalitis (10), status epilepticus (6), tetanus (6), and myasthenia gravis (3).


METHODS
Microbiologic surveillance samples of oropharyngeal and tracheal secretions, gastric aspirates, stool, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until 3 days after discharge from the unit. The SDD was applied every 6 h to the oropharynx and enterally.


RESULTS
Effective decontamination of the gastrointestinal tract was achieved in the patients receiving the active regimen; however, there was no reduction in the incidence of infections (11 in the active group vs 10 in placebo), and duration of ICU stay (30.1 +/- 22.5 vs 20.6 +/- 17.7 days) and hospital stay (49.3 +/- 31.9 vs 40 +/- 33.4 days) were unaffected as was the mortality (15 percent vs 15 percent).


CONCLUSIONS
SDD did not reduce the incidence of secondary infection in patients with neurologic disease, nor did it affect morbidity or mortality; however, it adds considerably to the cost of patient care.
Hammond
J M
JM
Respiratory Intensive Care Unit, Groote Schuur Hospital, Cape Town, South Africa.
Potgieter
P D
PD
D000284:Administration, Oral; D000328:Adult; D002439:Cefotaxime / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control*; D004064:Digestive System / Q000382:microbiology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal; D008297:Male; D009422:Nervous System Diseases / Q000628:therapy*; D011292:Premedication; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index
D002439:Cefotaxime