title: Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial.
abstract: BACKGROUND
  Selective decontamination of the digestive tract (SDD) is an infection-prevention regimen used in critically ill patients. We assessed the effects of SDD on intensive-care-unit (ICU) and hospital mortality, and on the acquisition of resistant bacteria in adult patients admitted to intensive care.
  
  
  METHODS
  We did a prospective, controlled, randomised, unblinded clinical trial. 934 patients admitted to a surgical and medical ICU were randomly assigned oral and enteral polymyxin E, tobramycin, and amphotericin B combined with an initial 4-day course of intravenous cefotaxime (SDD group n=466), or standard treatment (controls n=468). Primary endpoints were ICU and hospital mortality and the acquisition of resistant bacteria.
  
  
  RESULTS
  In the SDD group 69 (15%) patients died in the ICU compared with 107 (23%) in the control group (p=0.002). Hospital mortality was lower in the SDD groups than in the control group (113 [24%] vs 146 [31%], p=0.02). During their stay in intensive care, colonisation with gram-negative bacteria resistant to ceftazidime, ciprofloxacin, imipenem, polymyxin E, or tobramycin occurred in 61 (16%) of 378 SDD patients and in 104 (26%) of 395 patients in the control group (p=0.001). Colonisation with vancomycin-resistant enterococcus occurred in five (1%) SDD patients and in four (1%) controls (p=1.0). No patient in either group was colonised with meticillin-resistant Staphylococcus aureus.
  
  
  CONCLUSIONS
  In a setting with low prevalence of vancomycin-resistant enterococcus and meticillin-resistant S aureus, SDD can decrease ICU and hospital mortality and colonisation with resistant gram-negative aerobic bacteria.
authors.affiliation: Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands. e.dejonge@amc.uva.nl
authors.forename: Evert
authors.initials: E
authors.lastname: de Jonge
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Margaretha B
authors.initials: MB
authors.lastname: Vroom
authors.forename: Jacob
authors.initials: J
authors.lastname: Dankert
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001421:Bacteria, Anaerobic / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination / Q000379:methods*; D004064:Digestive System / Q000382:microbiology*; D004203:Disinfection / Q000379:methods*; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination / Q000517:prevention & control; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016106:Methicillin Resistance; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome; D020713:Vancomycin Resistance; D012122:Ventilators, Mechanical / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents