OROPHARYNGEAL DECONTAMINATION WITH GENTAMICIN FOR LONG-TERM VENTILATED PATIENTS ON STRESS-ULCER PROPHYLAXIS WITH SUCRALFATE

The incidence of nosocomial pneumonia in longterm ventilated patients has been reduced by stress ulcer prophylaxis with sucralfate. In a dou ble-blind trial we studied whether gentamicin administered topically t o the oropharynx (OPG) had additional clinical benefits in these patie nts. 67 critically ill adult patients fulfilled entry criteria for gre ater than or equal to 5 days on ventilation. The OPG group received 40 mg gentamicin, the control group received 5% dextrose topically admin istered to the oropharynx 4 times a day. During OPG, pharyngeal coloni zation rate (21 vs 44%) and tracheal secretion colonization rate (12 v s 41%) were significantly lower than during placebo (p < 0.05). Despit e these differences nosocomial pneumonia rate (3 vs 12%), duration of mechanical ventilation [15.8 +/- 11.1 vs 19.9 +/- 37.5 days (means +/- SD)] and mortality (27 vs 41%) were not significantly affected by OPG . Moreover, 13 of 15 bacteria (87%) that occurred during OPG were resi stant to gentamicin. Despite its reduction of bacterial colonization r ates of pharyngeal and tracheal secretions, OPG did not seem to offer additional clinical benefits in long-term mechanically ventilated pati ents on stress ulcer prophylaxis with sucralfate.