SHORT-TERM IMPACT OF THE EUROPEAN CONSENSUS CONFERENCE ON THE USE OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT WITH ANTIBIOTICS IN ICU PATIENTS

Because it remained controversial, the use of selective digestive deco ntamination (SDD) in patients in the intensive care unit (ICU) was cho sen as the topic of the first European Consensus Conference in Intensi ve Care Medicine (ECCICM) in December, 1991. The Consensus Bureau deci ded to assess the impact of this conference 2 years afterwards, For th is purpose, a questionnaire was sent to the members of the European So ciety of Intensive Care Medicine, the Societe de Reanimation de Langue Francaise and the Societe Francaise d'Anesthesie et Reanimation befor e the conference, The recommendations following the conference discour aged the systematic use of SDD in ventilated patients and urged the mo nitoring of bacterial resistance and adapting antibiotics to epidemiol ogy of the units, Two years after the conference, the same questionnai re mras sent to those physicians who had responded to the first one, E ighteen percent used SDD for all ventilated patients and 17% remain us ers after 2 years. Among the occasional (32%) or continual (17%) users of SDD, the regimens used were mostly intravenous cefotaxime (60% of systemic antibiotics) and a topical combination of polymixin E, tobram ycin, and amphotericin B (62% of overall topical combinations). The an tibiotics used were unchanged after 2 years in almost all cases. In co nclusion, the short-term impact of the Consensus Conference on SDD in ICU patients has been poor. This map be related to the continuing insu fficiency of strong, definite data regarding the impact of this techni que upon mortality and the theoretical risk of resistance to antibioti cs, thus allowing physicians to stick to their policies until there is new evidence.