Document Detail


Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU.
MedLine Citation:
PMID:  8933577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD. OBJECTIVE: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients. DESIGN: Retro- and prospective follow-up. PATIENTS: Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis. RESULTS: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)). CONCLUSION: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.
Authors:
H A Tissot van Patot; J A Leusink; J Roodenburg; B M de Jongh; H S Lau; S de Boer; A de Boer
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Pharmacy world & science : PWS     Volume:  18     ISSN:  0928-1231     ISO Abbreviation:  Pharm World Sci     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1997-02-20     Completed Date:  1997-02-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9307352     Medline TA:  Pharm World Sci     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  171-7     Citation Subset:  IM    
Affiliation:
Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Pharmacy, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Child
Cross Infection / prevention & control*
Digestive System / drug effects*,  microbiology*
Female
Follow-Up Studies
Gram-Negative Bacterial Infections / prevention & control*
Humans
Intensive Care Units*
Length of Stay
Male
Middle Aged
Postoperative Care*
Prospective Studies
Retrospective Studies
Ventilators, Mechanical
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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