Abstract
Objective: To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients. Design: A prospective, randomized, non-blinded and controlled clinical microbiology study. Setting: 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. Patients: Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation.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. Intervention: 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. Method: 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). Measurements and main 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.
Similar content being viewed by others
References
Welliver R, McLaughlin S. Unique epidemiology of nosocomial infection in a children's hospital. Am J Dis Child 1984; 138: 131–135.
Daschner F, Saal E. Nosocomial infections in a children's hospital. Results of a prospective study covering 3 1/2 years. Monatsschr Kinderheilkd 1981; 1129: 578–580.
Derter OP. Nosocomial infection in a children's hospital. A retrospective study. J Hyg Epidemiol Mierobiol Immunol 1986; 30: 149–153.
Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1986; 320: 1714–1721.
Donowitz LG. High risk of nosocomial infection in the pediatric critical care patient. Crit Care Med 1986; 14: 26–28.
Milliken J, Tait GA, Ford-Jones E, et al. Nosocomial infections in a pediatric intensive care unit. Crit Care Med 1988; 16: 233–237.
EPIC Study Co-ordinator: Nosocomial infection in ICU in 1992. A European perspective. Intensive Care World 1992; 92: 24–25.
Brown RB, Stechenberg B, Sandsm M, et al. Infections in a pediatric intensive care unit. Am J Dis Child 1987; 141: 267–270.
Rodríguez P, Herruzo R, Alvarado F, et al. Estudio prospectivo de la infección hospitalaria en una unidad de cuidados intensivos pediátricos. An C Intensivos 1988; 3: 35–39.
Wenzell RP. The evolving art and science of hospital epidemiology. J Infect Dis 1986; 153: 462–470.
Stoutenbeek CP, Van Saene HKF, Miranda DR, et al. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 1984; 10: 185–192.
Stoutenbeck CP, Van Saene HKF, Miranda DR, et al. The effect of oropharyngeal decontamination using topical nonabsorbable antibioties on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1984; 27: 357–364.
Unerti K, Ruckdeschel G, Selbmann H, et al. Prevention of colonization and respiratory infections in longterm ventilated patient by local antimierobial prophylaxis. Intensive Care Med 1987; 13: 106–113.
Van Uffelen R, Rommes J, Van Saene H. Preventing lower airway colonization and infection in mechanically ventilated patients. Crit Care Med 1987; 15: 99–102.
Wiesner R, Hermans P, Rakela J, et al. Selective bowel decontamination to prevent gram-negative bacterial and fungal infection following orthotopic liver transplantation. Transplant Proc 1987; 19: 2420–2423.
Kerver A, Rommes J, Mevissen-Verhage E, et al. Prevention of colonization and infection in critically patients: A prospective randomized study. Crit Care Med 1988; 16: 1087–1093.
Aerdtz SJA, Van Dalen R, Clasener HAL, et al. Prophylaxis of infection by selective decontamination in mechanically ventilated patients. Drugs 1988; 35(S2): 97–99.
Ledingham IM, Eastaway AT, McKay IC, et al. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1988; i: 785–790.
Zandstra DF, Stoutenbeek CP, Van Saene HK, et al. Selective decontamination of the digestive tract improves survival in patients receiving differential lung ventilation. Intensive Care Med 1988; 15: 15–18.
Ulrich C, Harinck de Weerd JE, Bakker NC, et al. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: A prospective randomized study. Intensive Care Med 1989; 15: 424–431.
Mc Clenlland P, Murray A, Williams P, et al. Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Crit Care Med 1990; 18: 935–939.
Tetteroo G, Wagenvoort J, Castelein A, et al. Selective decontamination to reduce gram-negative colonization and infections after oesophageal resection. Lancet 1990; 335: 704–707.
Flaherty J, Nathan C, Kabins S, et al. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 1990; 162: 1393–1397.
Godart J, Guillaume G, Reverdy ME, et al. Intestinal decontamination in a polyvalent ICU. A double blind study. Intensive Care Med 1990; 16: 1307–1311.
Rodríguez Roldán J, Altuna Cuesta A, López A, et al. Prevention of nosocomial lung infection in ventilated patients: Use of an antimierobial pharyngeal nonabsorbable paste. Crit Care Med 1990; 18: 1239–1242.
Sydow M, Burchardi H, Crozier TA, et al. Prospective study of infection and mortality rates in critically ill patients during DSD regimen. In: Van Saene HKF, Stoutenbeek CP, Lawin P, Ledingham I McA (eds), Update in Intensive Care and Emergency Medicine. Berlin: Springer-Verlag, 1988.
Brun-Buisson C, Legrand P, Rauss A, et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Ann Intern Med 1989; 110: 873–880.
Aerdts SJ, Van Dalen R, Clasener HAL, et al. Prophylaxis of infection by selective decontamination in mechanically ventilated patients. A preliminary report. Drugs 1988; 35(S2): 97–99.
Gastinne H, Wolff M, Delatour F, et al. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibioties. N Engl J Med 1992; 326: 594–599.
Zobel G, Kuttnig M, Grubbauer HM, et al. Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract. Crit Care Med 1991; 19: 1242–1246.
Aerdts SJ, Van Dalen RV, Clasener HAL, et al. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients. A prospective, blinded, randomized trial of the effect of a novel regimen. Chest 1991; 100: 783–791.
Hartenauer U, Thulig B, Diemer W, et al. Effect of selective flora suppression on colonization, infection, and mortality in eritically ill patients. A one-year, prospective consecutive study. Crit Care Med 1991; 19: 463–474.
Hammond JM, Pottgieter PD, Saunders GL, et al. Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992; 340: 5–9.
Selective Decontamination of the Digestive Tract Trialists Collaborative Group. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. Br Med J 1993; 307: 525–532.
Hammond JM, Potgieter PD, Saunders GL. Selective decontamination of the digestive tract in multiple trauma patients. Is there a role? Results of a prospective, double-blind, randomized trial. Crit Care Med 1994; 22: 33–39.
Bion JF, Badger L, Crosby HA, et al. Selective decontamination of the digestive tract reduces Gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation. Crit Care Med 1994; 22: 40–49.
Deitch EA, Maejima K, Berg R. Effect of oral antibiotics and bacterial overgrowth on the translocation of the GI tract microflora in burned rats. J Trauma 1985; 25: 385–392.
Wells CL, Jechorek RP, Erlandsen SL. Evidence for the translocation of Enterococcus faecalis across the mouse intestinal tract. J Infect Dis 1990; 162: 82–90.
Redan JA, Rush BJ, McCullough JN, et al. Organ distribution of radiolabeled enteric Escherichia coli during and after hemorrhagic shock. Ann Surg 1990; 211: 663–668.
Keene AR, Cullen DJ. Therapeutic intervention scoring system: Update 1983. Crit Care Med 1983; 11: 1–3.
Wilkinson JD, Pollack MM, Ruttimann UE, et al. Outcome of pediatrie patients with multiple organ system failure. Crit Care Med 1986; 14: 271–274.
Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16: 128–140.
Schaberg DR, Culver DH, Gaynes RP. Major trends in the mierobial aetiology of nosocomial infection. Am J Med 1991; 91(S3B): 72–75.
Gómez EC, Markowsky SJ, Rotschafer JC. Selective decontamination of the digestive tract in intensive care patients: review and commentary. Ann Pharmacother 1992; 26: 963–975.
Fink MP. Selective digestive decontamination: A gut issue for the nineties. Crit Care Med 1992; 20: 559–562.
Deitch EA. Selective decontamination of the gut. Is it enough? Crit Care Med 1990; 18: 1043–1044.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ruza, F., Alvarado, F., Herruzo, R. et al. Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. Eur J Epidemiol 14, 719–727 (1998). https://doi.org/10.1023/A:1007487330893
Issue Date:
DOI: https://doi.org/10.1023/A:1007487330893