SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT IN MULTIPLE TRAUMA PATIENTS - IS THERE A ROLE - RESULTS OF A PROSPECTIVE, DOUBLE-BLIND, RANDOMIZED TRIAL

Objective: To evaluate the efficacy of the technique of selective deco ntamination of the digestive tract in preventing the development of se condary infection and its influence on morbidity and mortality rates i n multiple trauma patients with chest injuries requiring intermittent positive-pressure ventilation. Design: Prospective, double-blind, rand omized study. Setting: A multidisciplinary respiratory intensive care unit (ICU) in a 1,500-bed teaching hospital. Patients: Seventy-two pat ients (mean Injury Severity Score of 29.5) who were intubated for >48 hrs and remained in the ICU for >5 days. Interventions: Patients were randomized on admission to receive selective decontamination therapy o r placebo. All patients received intravenous cefotaxime for 72 hrs and the treatment group received oral and enteral selective decontaminati on with amphotericin B, polymyxin E, and tobramycin (n = 39), while th e placebo group received a placebo containing oral paste and enteral s olution (n = 33). Measurements: Secondary infection was determined cli nically and microbiologically and surveillance cultures were monitored for gastrointestinal colonizationResults: The patient groups were ful ly comparable for age, severity of illness, and compromising factors, There was no difference in the number of patients infected (11 treatme nt group vs. 11 placebo), infections (17 vs. 16) and deaths (5 vs. 3); the duration of ICU (15.5 vs. 14.2 days) and hospital stays (26.3 vs. 25.5) were also similar. Microbiological surveillance cultures confir med effective elimination of aerobic Gram-negative bacilli, and infect ions in the treatment group were largely due to Staphylococcus aureus and Staphylococcus epidermidis. Conclusion: We have been unable to sho w any benefit from the use of selective decontamination of the digesti ve tract in the prevention of secondary infections in multiple trauma patients.