SELECTIVE DECONTAMINATION IN PEDIATRIC LIVER-TRANSPLANTS - A RANDOMIZED PROSPECTIVE-STUDY

Although it has been suggested that selective decontamination of the d igestive tract (SDD) decreases postoperative aerobic Gram-negative and fungal infections in orthotopic liver transplantation (OLT), no contr olled trials exist in pediatric patients. This prospective, randomized controlled study of 36 pediatric OLT patients examines the effect of short-term SDD on postoperative infection and digestive tract flora. P atients were randomized into two groups. The control group received pe rioperative parenteral antibiotics only. The SDD group received in add ition polymyxin E, tobramycin, and amphotericin B enterally and by oro pharyngeal swab postoperatively until oral intake was tolerated (6+/-4 days). Indications for operation, preoperative status, age, and inten sive care unit and hospital length of stay were no different in SDD (n =18) and control (n=18) groups. A total of 14 Gram-negative infections (intraabdominal abscess 7, septicemia 5, pneumonia 1, urinary tract 1 ) developed in the 36 patients studied. Mortality was not significantl y different in the two groups. However, there were significantly fewer patients with Gram-negative infections in the SDD group: 3/18 patient s (11%) vs. 11/18 patients (50%) in the control group, P<0.001. There was also significant reduction in aerobic Gram-negative flora in the s tool and pharynx in patients receiving SDD. Gram-positive and anaerobi c organisms were unaffected. We conclude that short-term postoperative SDD significantly reduces Gram-negative infections in pediatric OLT p atients.