Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial

E de Jonge*, MJ Schultz, L Spanjaard, PMM Bossuyt, MB Vroom, J Kesecioglu

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

495 Citations (Scopus)

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.

Findings 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.

Interpretation 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.

Original languageEnglish
Pages (from-to)1011-1016
Number of pages6
JournalLANCET
Volume362
Issue number9389
Publication statusPublished - 27-Sep-2003

Keywords

  • VENTILATOR-ASSOCIATED PNEUMONIA
  • CRITICALLY ILL PATIENTS
  • DOUBLE-BLIND
  • ANTIBIOTIC-PROPHYLAXIS
  • NOSOCOMIAL INFECTION
  • SURGICAL PATIENTS
  • CLINICAL-TRIAL
  • PREVENTION
  • UNIT
  • COLONIZATION

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