Selective decontamination of the digestive tract in severely burned pediatric patients

Infection is still one of the leading causes of morbidity and mortality in severely burned patients. Evidence suggests that many of the responsible or ganisms are endogenous. Systemic antibiotic prophylaxis is not effective, a nd produces resistant strains of microorganisms. SDD has been postulated to be beneficial for controlling and decreasing infections in critically ill patients. Its efficacy in severely burned patients. however, remains contro versial. In order to analyze the efficacy of selective decontamination of t he digestive (SDD) tract, to decrease the bacterial colonization of the aer odigestive tract and burn wounds, and the incidence of septic complications in severely burned children, 23 pediatric patients affected of severe burn s were prospectively randomized in a double-blinded study. Eleven patients received SDD (Polymyxin E, Tobramycin, and Amphotericin B), and 12 placebo. Demographics, hospital course. microbiology results, complications, infect ious episodes, and serum levels of IL-1 beta, IL-6, IL-10, and TNF-oc were compared to determine the efficacy of SDD. Colonization rates to the wound, sputum, nasogastric aspirates, and feces were similar. Pneumonia. sepsis a nd other complications had similar incidence in both groups. Serum levels o f all cytokines studied were also comparable, suggesting a similar inflamma tory status in all patients, regardless of the treatment received. Patients in the SDD group, however, had a significantly higher incidence of diarrhe a (P = 0.003). We can conclude that selective decontamination of the digest ive tract with Polymixin E, Tobramycin and Amphotericin B is not effective to decrease bacterial colonization and infectious episodes in severely burn ed pediatric patients. (C) 2001 Elsevier Science Ltd and ISBI. All rights r eserved.