title: Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU.
abstract: BACKGROUND
  Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.
  
  
  OBJECTIVE
  To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.
  
  
  METHODS
  Retro- and prospective follow-up.
  
  
  METHODS
  Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.
  
  
  RESULTS
  There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).
  
  
  CONCLUSIONS
  The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.
authors.affiliation: Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, Utrecht, The Netherlands.
authors.forename: H A
authors.initials: HA
authors.lastname: Tissot van Patot
authors.forename: J A
authors.initials: JA
authors.lastname: Leusink
authors.forename: J
authors.initials: J
authors.lastname: Roodenburg
authors.forename: B M
authors.initials: BM
authors.lastname: de Jongh
authors.forename: H S
authors.initials: HS
authors.lastname: Lau
authors.forename: S
authors.initials: S
authors.lastname: de Boer
authors.forename: A
authors.initials: A
authors.lastname: de Boer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D004064:Digestive System / Q000187:drug effects* / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012122:Ventilators, Mechanical
chemical_list: D000900:Anti-Bacterial Agents