SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT - EFFECT OF CESSATION OF ROUTINE APPLICATION AT AN ICU

Background: Selective decontamination of the digestive tract (SDD) wit h non-absorbable antibiotics was extensively used at intensive care un its (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrat ed that SDD did not influence hospital stay and mortality in these pat ients several ICU's decided to stop the routine use of SDD. Objective: To examine the effects of the cessation of SDD on nosocomial infectio ns, mortality and hospital stay at an ICU in post-operative patients. Design: Retro- and prospective follow-up. Patients: Post-operative pat ients with mechanical ventilation (MV) for greater than or equal to 5 days at an ICU were included. The retrospective group (SDD group) comp rised of 138 patients (mean age 66, range 10-91; 78% male) and the pro spective group (non-SDD group) of 142 patients (mean age 67, range 18- 85; 65% male). The SDD regime consisted of colistin, tobramycin and am photericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis. Results: There was a n onsignificant increase from an average 21 to 23 days ICU stay in th no n-SDD group when compared with the SDD group (p>0.05). Of the 280 pati ents 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 no n-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)). Co nclusion: The cessation of the routine application of SDD in post-oper ative patients mechanically ventilated for 5 days or more did nod adve rsely affect survival nor increased length of stay at the ICU. There m ay have been a shift to infections as a cause of death after cessation of SDD.