CONTINUOUS ENTERAL FEEDING COUNTERACTS PREVENTIVE MEASURES FOR GASTRIC COLONIZATION IN INTENSIVE-CARE UNIT PATIENTS

Objective: To test the influence of continuously administered enteral feeding on gastric pH and gastric colonization in patients receiving o r not receiving topical antimicrobial prophylaxis of the oropharynx an d stomach, including sucralfate as stress ulcer prophylaxis. Design: P rospective, open trial. Setting: Two university hospital general inten sive care units (ICUs). Patients: Patients (n = 95) with an ICU stay f or at least 5 days. Interventions: Thirty-one patients received antimi crobial agents into the stomach and oropharynx in combination with suc ralfate (1 g/6 hrs) as stress ulcer prophylaxis. Sixty-four other pati ents did not receive antimicrobial prophylaxis or sucralfate, but inst ead received gastric pH-increasing stress ulcer prophylactic agents, i f indicated. Gastric colonization and gastric pH were measured on admi ssion and subsequently at least two times a week. Forty-eight patients (14 receiving and 34 not receiving antimicrobial prophylaxis) receive d enteral feeding. Measurements and Main Results: Both enteral feeding and gastric pH-increasing stress ulcer prophylaxis independently incr eased gastric pH: the risks for a gastric pH of >3.5 were, respectivel y, 4.54 and 2.04 (odds ratios). Enteral feeding also increased the ris k for gastric colonization by potentially pathogenic microorganisms (o dds ratio = 4.52). Patients receiving both topical antimicrobial proph ylaxis and sucralfate remained free of gastric colonization for a long er period than those patients receiving gastric pH-increasing stress u lcer prophylaxis. In these two groups, patients without enteral feedin g remained free of gastric colonization for a longer period than those patients receiving enteral feeding. Conclusions: Topical antimicrobia l prophylaxis, including sucralfate, successfully prevented gastric co lonization with potentially pathogenic microorganisms and was correlat ed with lower gastric pH values. However, the efficacy was markedly de creased when continuous enteral feeding was administered simultaneousl y.