title: Does selective digestive decontamination prevent ventilator-associated pneumonia in trauma patients?
abstract: The incidence of ventilator-associated pneumonia (VAP) is particularly high in patients with trauma. The efficacy and safety of selective digestive decontamination (SDD) was not studied extensively. We aimed in our randomized double-blind, placebo-controlled study to evaluate whether SDD prevents VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit for multiple trauma with a predicted duration of mechanical ventilation (MV) over 48 hours were included. We included 44 patients who were divided into 4 groups: group A receiving subglottic and gastric treatment suspension (polymyxin E 100 mg, vancomycin 1 g, and amphotericin B 500 mg), group B receiving placebo, group C receiving subglottic placebo and gastric treatment suspension, and group D receiving subglottic treatment suspension and gastric placebo. The suspension was given 4 times a day during 7 consecutive days. To this topical treatment, we associated an intravenous administration of cefotaxime (1 g 3 times a day during 4 consecutive days). The incidence of VAP in the 4 groups was, respectively, 45.5%, 46.2%, 22.2%, and 27.3% (P=0.236). In multivariate analysis, none of the 3 tested regimens was identified as a protective factor against VAP. However, prolonged duration of MV was the only independent factor predicting VAP onset (odds ratio=1.1; 95% confidence interval [1.1-1.4]; P=0.049).
authors.affiliation: 1ICU Department, Faculté de Medicine de Sfax, Sfax, Tunisia 2Department of Clinical Pharmacy, Faculté de Pharmacie, Monastir, Tunisia.
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Emna
authors.initials: E
authors.lastname: Zribi
authors.forename: Hssan
authors.initials: H
authors.lastname: Dammak
authors.forename: Hatem
authors.initials: H
authors.lastname: Ghadoun
authors.forename: Kamilia
authors.initials: K
authors.lastname: Chtara
authors.forename: Souad
authors.initials: S
authors.lastname: Sfar
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002439:Cefotaxime / Q000008:administration & dosage; D002648:Child; D003091:Colistin / Q000008:administration & dosage; D003666:Decontamination / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D014640:Vancomycin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000666:Amphotericin B; D002439:Cefotaxime; D003091:Colistin