Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD).
OBJECTIVE
To determine the influence of selective oropharyngeal decontamination (SOD) on the rate of colonization and infection of the respiratory tract in intensive care patients requiring mechanical ventilation for more than 4 days. A financial assessment was also performed.


METHODS
Randomized, prospective, controlled study using amphotericin B, colistin sulfate (polymyxin E), and tobramycin applied to the oropharynx and systemic cefotaxime prophylaxis.


METHODS
Anesthesiology intensive care unit (ICU) of a 1500-bed hospital.


METHODS
A total of 88 patients admitted as emergencies and intubated within less than 24 h were enrolled. Fifty-eight patients received SOD and 30 patients served as controls. Randomization was in the proportion of 2 : 1 study patients to controls.


METHODS
Microbiological samples from the oropharynx and other infected sites were taken at the time of admission, then twice a week and after extubation.


RESULTS
With the use of SOD, colonization was significantly reduced. Furthermore, the infection rate decreased from 77% in the controls to 22% in the study patients. Staphylococcus aureus was the main potential pathogen causing colonization and pneumonia. Number of days in the ICU, duration of ventilation, and mortality were not significantly decreased. The total cost of antibiotics was reduced. Development of resistance was not observed.


CONCLUSIONS
The use of SOD significantly reduced the colonization and pneumonia and the total charge for antibiotics. The length of stay in the ICU, duration of ventilation, and mortality were similar. No resistance was observed. Staphylococcus aureus was selected by SOD in some patients and the clinical relevance needs further observation.
Abele-Horn
M
M
Max von Pettenkofer-Institut, Ludwig-Maximilians-Universität, München, Germany.
Dauber
A
A
Bauernfeind
A
A
Russwurm
W
W
Seyfarth-Metzger
I
I
Gleich
P
P
Ruckdeschel
G
G
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003091:Colistin / Q000627:therapeutic use*; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009960:Oropharynx / Q000187:drug effects / Q000382:microbiology*; D011014:Pneumonia / Q000401:mortality / Q000517:prevention & control*; D012121:Respiration, Artificial; D014031:Tobramycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D014031:Tobramycin; D003091:Colistin