Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial

• Published in: American journal of respiratory and critical care medicine 1998-09, Vol.158 (3), p.908-916
• Main Authors: Sánchez García, M, Cambronero Galache, J A, López Diaz, J, Cerdá Cerdá, E, Rubio Blasco, J, Gómez Aguinaga, M A, Núnez Reiz, A, Rogero Marín, S, Onoro Canaveral, J J, Sacristán del Castillo, J A
• Format: Article
• Language: English
• Subjects: Bacteria - drug effects; Bacterial Infections - prevention & control; Cause of Death; Ceftriaxone - therapeutic use; Cephalosporins - therapeutic use; Colony Count, Microbial; Confidence Intervals; Critical Care; Critical Illness; Digestive System - microbiology; Double-Blind Method; Drug Therapy, Combination - economics; Drug Therapy, Combination - therapeutic use; Female; Gram-Negative Bacteria - drug effects; Gram-Positive Bacteria - drug effects; Health Care Costs; Humans; Incidence; Intubation, Intratracheal - adverse effects; Length of Stay; Male; Middle Aged; Oropharynx - microbiology; Placebos; Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - prevention & control; Respiration, Artificial - adverse effects; Survival Rate
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.158.3.9712079

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.