Daniel D. Dressler, MD, MSc; Amir K. Jaffer, MD
Does selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD) reduce mortality in patients in the intensive care unit (ICU)?
Cluster-randomized, crossover, controlled trial. Controlled Clinical Trials ISRCTN35176830.
13 ICUs in the Netherlands.
5939 patients (mean age 62 y, 62% men) who were recently admitted to the ICU and expected to stay > 3 days or to be on mechanical ventilation for > 2 days.
SDD, consisting of intravenous cefotaxime for 4 days and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach every 6 hours until ICU discharge (n = 2045); SOD, consisting of topical application (as above) to the oropharynx only (n = 1904); or standard care (n = 1990). During the SDD treatment period, use of antibiotics with antianerobic activity was discouraged, but there was no restriction on systemic antibiotic therapy during the other 2 treatment periods. Each ICU administered each of the 3 interventions for 6 months.
Mortality at 28 days, in-hospital mortality, prevalence of antibiotic resistance (assessed monthly), and duration of mechanical ventilation, ICU stay, and hospital stay.
99% (intention-to-treat analysis).
Both SDD and SOD reduced mortality compared with standard care (Table). SDD slightly shortened hospital stay compared with standard care, but reductions in duration of mechanical ventilation, ICU stay, and hospital stay (SOD vs standard care) did not reach statistical significance. The prevalence of antibiotic-resistant pathogens was not increased with either intervention; in many cases, prevalence was lower during SDD treatment than during standard care or SOD.
Selective decontamination of the digestive tract and selective oropharyngeal decontamination reduced mortality to a similar extent in patients in the intensive care unit.
Selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD) vs standard care in the intensive care unit†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from odds ratios in article, adjusted for APACHE II score, age, sex, intubation status, and reason for ICU admission.
Daniel D. Dressler, Amir K. Jaffer. Selective decontamination of the digestive tract and selective oropharyngeal decontamination reduced mortality in the ICU. Ann Intern Med. 2009;150:JC5–5. doi: 10.7326/0003-4819-150-10-200905190-02005
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Published: Ann Intern Med. 2009;150(10):JC5-5.
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