Am. J. Respir. Crit. Care Med., Volume 158, Number 3, September 1998, 908-916

Effectiveness and Cost of Selective Decontamination of the Digestive Tract in Critically Ill Intubated Patients
A Randomized, Double-blind, Placebo-controlled, Multicenter Trial

MIGUEL SÁNCHEZ GARCÍA, JOSÉ A. CAMBRONERO GALACHE, JULIA LÓPEZ DIAZ, ENRIQUE CERDÁ CERDÁ, JOSÉ RUBIO BLASCO, MIGUEL A. GÓMEZ AGUINAGA, ANTONIO NÚÑEZ REIZ, SANTIAGO ROGERO MARÍN, JUAN J. OÑORO CAÑAVERAL, and JOSÉ A. SACRISTÁN del CASTILLO

Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Hospital La Paz; Hospital Central de la Cruz Roja; Hospital Doce de Octubre; and Hospital Severo Ochoa, Leganés, Madrid, Spain

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16.5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0.05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group. Sánchez

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