Title of article :
Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial
Author/Authors :
Evert de Jonge، نويسنده , , Marcus J Schultz، نويسنده , , Lodewijk Spanjaard، نويسنده , , Patrick M.M. Bossuyt، نويسنده , , Margaretha B Vroom، نويسنده , , Jacob Dankert، نويسنده , , Jozef Kesecioglu، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2003
Pages :
6
From page :
1011
To page :
1016
Abstract :
Background Selective decontamination of the digestive tract (SDD) is an infection-prevention regimen used in critically ill patients. We assessed the effects of SDD on intensive-care-unit (ICU) and hospital mortality, and on the acquisition of resistant bacteria in adult patients admitted to intensive care Methods We did a prospective, controlled, randomised, unblinded clinical trial. 934 patients admitted to a surgical and medical ICU were randomly assigned oral and enteral polymyxin E, tobramycin, and amphotericin B combined with an initial 4-day course of intravenous cefotaxime (SDD group n=466), or standard treatment (controls n=468). Primary endpoints were ICU and hospital mortality and the acquisition of resistant bacteria. Findings In the SDD group 69 (15%) patients died in the ICU compared with 107 (23%) in the control group (p=0•002). Hospital mortality was lower in the SDD groups than in the control group (113 [24%] vs 146 [31%], p=0•02). During their stay in intensive care, colonisation with gram-negative bacteria resistant to ceftazidime, ciprofloxacin, imipenem, polymyxin E, or tobramycin occurred in 61 (16%) of 378 SDD patients and in 104 (26%) of 395 patients in the control group (p=0•001). Colonisation with vancomycin-resistant enterococcus occurred in five (1%) SDD patients and in four (1%) controls (p=1•0). No patient in either group was colonised with meticillin-resistant Staphylococcus aureus. Interpretation In a setting with low prevalence of vancomycin-resistant enterococcus and meticillin-resistant S aureus, SDD can decrease ICU and hospital mortality and colonisation with resistant gram-negative aerobic bacteria
Journal title :
The Lancet
Serial Year :
2003
Journal title :
The Lancet
Record number :
559665
Link To Document :
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