SELECTIVE INTESTINAL DECONTAMINATION IN MULTIPLE TRAUMA PATIENTS - PROSPECTIVE, CONTROLLED TRIAL

Background: Reduction of potential pathogens by selective intestinal d econtamination has been proposed to improve intensive care. Despite la rge scientific interest in this method, little is known about its bene fit in homogeneous trauma populations, Methods: In a prospective, cont rolled study, we enrolled noninfected trauma patients (age over 18 yea rs, mechanical ventilation greater than or equal to 48 hours, intensiv e care for more than 3 days) who primarily were admitted to our univer sity medical center, We randomized patients to be treated with two dif ferent topical regimens (polymyxin, tobramycin, and amphotericin (PTA) or polymyxin, ciprofloxin, amphotericin (PCA)) or the carrier only (p lacebo), administered four times daily both to the oropharynx and to t he gastrointestinal tract, All patients received intravenous ciproflox acin (200 mg, bd) for 4 days, Findings: Of 357 enrolled patients, 310 (age 38.0 +/- 16.5 years, injury Severity Score 35.2 +/- 12.7) met all inclusion criteria. Selective decontamination successfully reduced in testinal bacterial colonization, However, we did not identify signific ant differences between groups regarding pneumonia (PTA 47.5%, PCA 39. 0%, placebo 45.3%), sepsis (PTA 47.5%, PCA 37.8%, placebo 42.6%), mult iple organ failure (PTA 56.3%; PCA 52.4%, placebo 58.1%), and death (P TA 11.3%, PCA 12.2%, placebo 10.8%), Total costs per patient were high est with the PTA regimen, Conclusions: We found no benefit of selectiv e decontamination in trauma patients, Apparently, bacterial overgrowth in the intestinal tract is not the sole link between trauma, sepsis, and organ failure.