Microbiological and clinical effect of selective bowel decontamination in transthoracic resections of the carcinoma of the esophagus and cardia

Introduction: Surgical therapy of carcinoma of the esophagus or cardia by t ransthoracic esophageal resection is associated with a high morbidity in wh ich nosocomial infections have a great importance. This study investigates the influence of prophylactic selective bowel decontamination on the course and results of transthoracic resection of the esophagus. Methods: Seventy patients with carcinoma of the esophagus and cardia were included in this p rospective and partially randomized study at the University of Heidelberg. Twenty-five patients received prophylactically selective bowel decontaminat ion with tobramycin, polymyxin B and amphotericin B. The treatment course w as documented uniformly. In addition, microbiological screening was perform ed by swab examinations of nose, throat and anus, by urine and blood cultur es, and the documentation of results of additional microbiological diagnost ic studies. Results: Bacteriological screening confirmed a reduction in inf ectious agents and a change of their spectrum in the respiratory and digest ive tract without an increase in multiresistent bacteria. Patients who rece ived selective bowel decontamination had a lower infection rate, a shorter artificial respiration period and a shorter intensive care stay without sta tistically significant differences. The mortality rate was 4% vs 9% in the control group (95% confidence interval -0.172-0.116). Conclusion: This stud y confirms the feasibility and microbiological effectiveness of selective b owel decontamination in the context of surgical therapy which is associated with a high nosocomial infection rate. The result of the clinical treatmen t seems slightly more favorable in the treatment group. Decisive are compli cations caused by surgery which fundamentally determine the clinical course and frequently cause infectious complications. The prophylactic use of sel ective bowel decontamination may be useful in patients with an increased ri sk of prolonged ventilation support or colon interposition but it is not to be generally recommended.