Patients in intensive-care units (ICUs) could have better survival outcomes with the preventative use of antibiotics to remove potentially harmful bacteria from the mouth, stomach and gut. This process--known as selective decontamination of the digestive tract (SDD)--reduces the risk of respiratory-tract infection for ICU patients requiring mechanical ventilation.

Selective use of SDD has occurred for two decades although its effect on infection with antibiotic-resistant bacteria and death is not clear. In a randomised unblinded trial, Evert de Jonge from Amsterdam's Academic Medical Center, Netherlands, and colleagues randomised 934 patients admitted to a surgical and medical ICU to receive either appropriate antibiotic treatment to facilitate SDD, or standard treatment (the control group).

There were fewer deaths in ICUs (15%) and fewer overall hospital deaths (24%) among SDD patients compared with those given standard treatment (23% and 31%, respectively). Infection with antibiotic-resistant bacteria in ICUs was also lower among SDD patients (16%) than patients given standard treatment (26%).

Evert de Jonge comments: "We conclude that SDD may improve survival of ICU patients and lowers the acquisition of resistant gram-negative aerobic bacteria. In ICUs that have low prevalence of vancomycin-resistant enterococcus and meticillin-resistant S aureus, we advocate the use of SDD in all patients expected to be on mechanical ventilation for at least 2 days or to be in the ICU for at least 3 days."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
25-Sep-2003

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