The Lancet, Volume 362, Issue 9389, Pages 1011 - 1016, 27 September 2003 <Previous Article|Next Article>doi:10.1016/S0140-6736(03)14409-1Cite or Link Using DOI

Dr Evert de Jonge MD a , Marcus J Schultz MD a, Lodewijk Spanjaard MD b, Prof Patrick MM Bossuyt MD c, Prof Margaretha B Vroom MD a, Prof Jacob Dankert MD b, Jozef Kesecioglu MD d
Summary

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-care-unit (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 vancomycin-resistant enterococcus and meticillin-resistant S aureus, SDD can decrease ICU and hospital mortality and colonisation with resistant gram-negative aerobic bacteria.