Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial.
We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.
Sánchez García
M
M
Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Hospital La Paz; Hospital Central de la Cruz Roja; Hospital Doce de Octubre; and Hospital Severo Ochoa, Leganés, Madrid, Spain.
Cambronero Galache
J A
JA
López Diaz
J
J
Cerdá Cerdá
E
E
Rubio Blasco
J
J
Gómez Aguinaga
M A
MA
Núnez Reiz
A
A
Rogero Marín
S
S
Onoro Canaveral
J J
JJ
Sacristán del Castillo
J A
JA
D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000517:prevention & control; D002423:Cause of Death; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D015169:Colony Count, Microbial; D016001:Confidence Intervals; D003422:Critical Care; D016638:Critical Illness; D004064:Digestive System / Q000382:microbiology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D010919:Placebos; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects; D015996:Survival Rate
D002511:Cephalosporins; D010919:Placebos; D002443:Ceftriaxone