【柳叶刀】Effects of selective decontamination of digestive tract on mortality a

蓝鱼o_0

Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial

Summary
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-careunit (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 vancomycinresistant enterococcus and meticillin-resistant S aureus, SDD can decrease ICU and hospital mortality and colonisation with resistant gram-negative aerobic bacteria.