A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation.
BACKGROUND
Bacterial infection is a frequent, morbid, and mortal complication of liver transplantation. Selective bowel decontamination (SBD) has been reported to reduce the rate of bacterial infection after liver transplantation in uncontrolled trials, but benefits of this intervention have been less clear in controlled studies.


METHODS
Eighty candidates for liver transplantation were randomly assigned in a double-blinded fashion to an SBD regimen consisting of gentamicin 80 mg+polymyxin E 100 mg+nystatin 2 million units (37 patients) or to nystatin alone (43 patients). Both treatments were administered orally in 10 ml (increasing to 20 ml, according to predefined criteria), four times daily, through day 21 after transplantation. Anal fecal swab cultures were performed on days 0, 4, 7, and 21. Rates of infection, death, and charges for medical care were assessed from day 0 through day 60.


RESULTS
More than 85% of patients in both treatment groups began study treatment more than 3 days before transplantation. Rates of infection (32.4 vs. 27.9%), death (5.4 vs. 4.7%), or charges for medical care (median $194,000 vs. $163,000) were not reduced in patients assigned to SBD. On days 0, 4, 7, and 21, growth of aerobic gram-negative flora in fecal cultures of patients assigned to SBD was significantly less than that of patients taking nystatin alone; growth of aerobic gram-positive flora, anaerobes, and yeast was not significantly different.


CONCLUSIONS
Routine use of SBD in patients undergoing liver transplantation is not associated with significant benefit.
Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA.
Walter C
WC
Hellinger
Joseph D
JD
Yao
Salvador
S
Alvarez
Janis E
JE
Blair
John J
JJ
Cawley
Carlos V
CV
Paya
Peter C
PC
O'Brien
James R
JR
Spivey
Rolland C
RC
Dickson
Denise M
DM
Harnois
David D
DD
Douglas
Christopher B
CB
Hughes
Justin H
JH
Nguyen
David C
DC
Mulligan
Jeffrey L
JL
Steers
D003091:Colistin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006088:Gram-Negative Aerobic Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009761:Nystatin / Q000627:therapeutic use*; D011446:Prospective Studies; D015003:Yeasts / Q000187:drug effects / Q000302:isolation & purification*
D005839:Gentamicins; D009761:Nystatin; D003091:Colistin