IS THERE A ROLE FOR SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT IN PRIMARILY INFECTED PATIENTS IN THE ICU

The role of selective decontamination of the digestive tract (SDD) for the prevention of nosocomial infection in critically ill patients rem ains controversial, and the efficacy of this technique in patients who are already infected on presentation to the intensive care unit has n ot previously been assessed. We performed a double-blind randomized pl acebo controlled trial of SDD (parenteral cefotaxime, six-hourly oral and enteral polymyxin E, tobramycin, and amphotericin B vs placebo) fo r all infected patients presenting to the ICU requiring mechanical ven tilation for more than 48 hours and ICU stay of more than 5 days. Dail y clinical and microbiological monitoring for secondary infection was undertaken until hospital discharge. In all, 59 selective decontaminat ion and 76 placebo fully comparable patients fulfilled criteria for en rolment and analysis (APACHE II 15.2 vs 15.1). The number of patients receiving SDD who developed nosocomial infections was significantly re duced (P = 0.048) and there were no infections caused by the enterobac teriaceae or Candida spp in this group. No difference in ICU (17.5 vs 18.8 days) or hospital stay (32.7 vs 34.2 days) or mortality (17% vs 2 2.3%) was shown. Critically ill, primarily infected patients are prote cted from nosocomial infection by the use of SDD.