DECREASE IN NOSOCOMIAL PNEUMONIA IN VENTILATED PATIENTS BY SELECTIVE OROPHARYNGEAL DECONTAMINATION (SOD)

Objective: To determine the influence of selective oropharyngeal decon tamination (SOD) on the rate of colonization and infection of the resp iratory tract in intensive care patients requiring mechanical ventilat ion for more than 4 days, A financial assessment was also performed. D esign: Randomized, prospective, controlled study using amphotericin B, colistin sulfate (polymyxin E), and tobramycin applied to the orophar ynx and systemic cefotaxime prophylaxis. Setting: Anesthesiology inten sive care unit (ICU) of a 1500-bed hospital. Patients: A total of 88 p atients admitted as emergencies and intubated within less than 24 h we re enrolled. Fifty- eight patients received SOD and 30 patients served as controls. Randomization was in the proportion of 2 : 1 study patie nts to controls. Interventions: Microbiological samples from the oroph arynx and other infected sites were taken at the time of admission, th en twice a week and after extubation. Measurements and results: With t he use of SOD, colonization was significantly reduced. Furthermore, th e infection rate decreased from 77 % in the controls to 22 % in the st udy patients. Staphylococcus aureus was the main potential pathogen ca using colonization and pneumonia. Number of days in the ICU, duration of ventilation, and mortality were not significantly decreased. The to tal cost of antibiotics was reduced. Development of resistance was not observed. Conclusions: The use of SOD significantly reduced the colon ization and pneumonia and the total charge for antibiotics. The length of stay in the ICU, duration of ventilation, and mortality were simil ar. No resistance was observed. Staphylococcus aureus was selected by SOD in some patients and the clinical relevance needs further observat ion.