Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination.
OBJECTIVE
To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients.


METHODS
A prospective, randomized, non-blinded and controlled clinical microbiology study.


METHODS
The pediatric intensive care unit (PICU) of a tertiary level pediatric university hospital. CRITERIA FOR INCLUSION: Patients 1 month to 14 years old, who underwent some kind of manipulation or instrumentation (mechanical ventilation, vascular cannulation, monitoring of intracranial pressure, thoracic or abdominal drainage, bladder catheterization, peritoneal dialysis, etc.) and/or presented a neurological coma requiring a stay in the PICU of 3 or more days.


METHODS
Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation. The treatment group comprised 116 patients and the control group, 110 patients.


METHODS
The treatment group received a triple therapy of colimycin, tobramycin and nystatin administered orally or via nasogastric tube every 6 hours. All patients with mechanical ventilation or immune-depression received decontamination treatment of the oropharyngeal cavity with hexitidine (Oraldine 0.5 mg/ml) every 6-8 hours in accordance with the PICU's conventional protocol.


METHODS
Up to 10 types of nosocomial infection were diagnosed following criteria of the Centers for Disease Control (CDC). The severity and manipulation of the patients on admission was assessed using the therapeutic intervention scoring system (TISS) and multi-organ system failure scores (MOSF).


RESULTS
UNIVARIANT ANALYSIS: SDD did not significantly reduce the incidence of NI, antibiotic use, the length of stay, or mortality; although a small percentage of respiratory and urinary tract infections was detected, catheter-related bacteremia was the most common infection. MULTIVARIANT ANALYSIS: Controlling the risk factors for each child through log regression showed that SDD acted as a protective factor for more than 90% of the sample with respect to the appearance of respiratory and urinary tract infections, reducing the risk of such infections to 1/5 and 1/3, respectively.


CONCLUSIONS
SDD was effective in controlling respiratory and urinary tract infections in children admitted to the PICU, but it did not reduce the incidence of other types of nosocomial infection.
Ruza
F
F
Servicio de Cuidados Intensivos Pediátricos Hospital Infantíl La Paz, Madrid, Spain.
Alvarado
F
F
Herruzo
R
R
Delgado
M A
MA
García
S
S
Dorao
P
P
Goded
F
F
D000293:Adolescent; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004064:Digestive System / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006590:Hexetidine / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure; D015999:Multivariate Analysis; D009761:Nystatin / Q000627:therapeutic use; D011446:Prospective Studies; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000517:prevention & control; D012720:Severity of Illness Index; D014031:Tobramycin / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000517:prevention & control
D009761:Nystatin; D006590:Hexetidine; D014031:Tobramycin; D003091:Colistin