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Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial.
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- Author(s): de Jonge, Evert; Schultz, Marcus J.; Spanjaard, Lodewijk; Bossuyt, Patrick M. M.; Vroom, Margaretha B.; Dankert, Jacob; Kesecioglu, Jozef
- Source:
Lancet. 9/27/2003, Vol. 362 Issue 9389, p1011-1016. 6p. 1 Diagram, 6 Charts, 1 Graph.
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- 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-careunit (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 vancomycinresistant enterococcus and meticillin-resistant S aureus, SDD can decrease ICU and hospital mortality and colonisation with resistant gram-negative aerobic bacteria. [ABSTRACT FROM AUTHOR]
- Abstract:
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