Elsevier

The Lancet

Volume 340, Issue 8810, 4 July 1992, Pages 5-9
The Lancet

ORIGINAL ARTICLES
Double-blind study of selective decontamination of the digestive tract in intensive care

https://doi.org/10.1016/0140-6736(92)92422-CGet rights and content

Abstract

Selective decontamination of the digestive tract (SDD), by means of non-absorbable antibiotics, to prevent infection in intensive-care units (ICUs) remains controversial; there is evidence that the regimen reduces the incidence of secondary infection, but no convincing reduction in morbidity or mortality has been shown and the costs and effect on microbial resistance patterns need further study. In a double-blind, placebo-controlled trial, we have tried to find out whether SDD should be used routinely in all ICU patients at high risk of secondary infection.

All patients admitted to the ICU who were thought likely to stay in the unit for at least 5 days and to need intubation for longer than 48 h were enrolled and randomly allocated to groups receiving placebo or SDD (amphotericin, colistin, and tobramycin applied to the oropharynx and enterally); all patients received intravenous cefotaxime for 72 h. Of 322 patients randomised, 83 were withdrawn (80 ICU stay or duration of intubation too short, 3 protocol violations). 239 medical, trauma, and surgical patients completed the trial period (114 SDD, 125 placebo). There were no differences between SDD and placebo groups in incidence of infection (30 [26%] vs 43 [34%] patients; p=0·22), duration of ICU stay (mean 16·2 [14·3] vs 16·8 [12·3] days), hospital stay (29·9 [SD 25·0] vs 31·9 [22·2] days), or mortality (21 [18%] vs 21 [17%]). SDD substantially increased the costs of intensive care.

Mechanisms other than bacterial colonisation of the gut may bring about substantial numbers of secondary infections in ICUs. Routine use of SDD in multidisciplinary ICUs cannot be recommended.

References (29)

  • Wa Knaus et al.

    Prognosis in acute organ system failure

    Ann Surg

    (1985)
  • Sp Baker et al.

    The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care

    J Trauma

    (1974)
  • Dd Tran et al.

    Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit

    Crit Care Med

    (1990)
  • Cp Stoutenbeek et al.

    The effect of oropharyngeal decontamination using topical non-absorbable antibiotics on the incidence of nosocomial respiratory tract infection in multiple trauma patients

    J Trauma

    (1987)
  • Cited by (199)

    • Ventilator-Associated Tracheobronchitis

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    • Effect of selective decontamination on antimicrobial resistance in intensive care units: A systematic review and meta-analysis

      2013, The Lancet Infectious Diseases
      Citation Excerpt :

      Finally, two groups of investigators followed up cohorts from RCTs of SDD12,41 with before-and-after studies52,86 examining changes in resistance rates before introduction of the SDD intervention and after removal of SDD after the trial. A 2 year trial in a South African ICU41 detected a reduction in cefotaxime-resistant Enterobacteriaceae (p=0·02), and no statistically significant changes in MRSA or aminoglycoside-resistant Gram-negative bacilli.52 By contrast with these findings, an ecological analysis of the 6 months after versus the 6 month before an SDD intervention in a large crossover RCT in the Netherlands showed an increase in intestinal colonisation with resistant Gram-negative bacilli; ceftazidime resistance increased from 5% to 15%, tobramycin resistance increased from 7% to 13%, and ciprofloxacin resistance increased from 7% to 13% (p<0·05 for all comparisons).86

    • Use of Colistin in Critically Ill Patients

      2019, Advances in Experimental Medicine and Biology
    View all citing articles on Scopus
    View full text