A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF SELECTIVE DIGESTIVE DECONTAMINATION IN A MEDICAL-SURGICAL INTENSIVE-CARE UNIT

A randomized, double-blind, placebo-controlled trial of selective deco ntamination of the oropharynx and gastrointestinal tract was conducted on 61 intubated patients in a medical-surgical intensive care unit (I CU) to determine the impact on nosocomial pneumonia, other infections, and emergence of colonization or infection with antibiotic-resistant bacteria. Over 8 months, 30 patients received an oral paste and soluti on containing polymyxin, gentamicin, and nystatin; 31 patients receive d a placebo paste and solution. At study entry, patients in both group s were I seriously ill (mean acute physiologic score, 27.2), frequentl y had pulmonary infiltrates (73.8%), and were likely to be receiving s ystemic antibiotics (86.9%). There were no differences between study p atients and control patients in these characteristics or in frequency of any nosocomial infection (50% vs. 55%), nosocomial pneumonia (27% v s. 26%), febrile days (2.3 vs. 2.0), duration of antibiotic therapy (1 4.0 vs, 13.4), or mortality rates (37% vs. 48%). There was no differen ce in infections caused by antibiotic-resistant gram-negative bacilli, although a trend towards more frequent infection with gentamicin-resi stant enterococci was found for study patients. Selective decontaminat ion did not appear to be effective in our very ill medical-surgical IC U patients, although the number of patients in our trial was sufficien t to detect only a 50% or greater reduction in pneumonia rates.