Abstract
A double-blind randomized placebo-controlled study was carried out to evaluate the efficacy and the cost of selective digestive decontamination (SDD) to prevent nosocomial pneumonia in multiple-trauma patients. Nosocomial infections, particularly pneumonia, were more frequent in the placebo group. The most common infectious agent wasStaphylococcus: Staphylococcus aureus in the placebo group andStaphylococcus epidermidis in the SDD group. Methicillin-resistantStaphylococcus epidermidis was detected more often in the SDD group. No methicillin-resistantStaphylococcus aureus was observed in this study. Fewer patients in the SDD group required antibiotherapy. SDD resulted in a saving of about 41% in drug expenditure.
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Maki DG, Risk factors for nosocomial infection in intensive care. Devices in nature and goals for the next decade. Arch Intern Med 1989;149:30–5.
Donovitz LG, Wenzel RP, Hoyt JW. Risk of hospital acquired infection in the ICU patient. Crit Care Med 1982;10:355–7.
Thorp JM, Richards WC, Telfer ABM. A survey of infection in an intensive care unit. Anaesthesia 1979;68:643–50.
Atherton ST, White DJ. Stomach as a source of bacteria colonizing respiratory tract during artificial ventilation. Lancet 1978;2:968–9.
Gastinne H, Wolf FM, Delatour F, Faurisson F, Chevret S. A controlled trial in intensive care units of selective digestive decontamination of the digestive tract with non absorbable antibiotics. N Engl J Med 1992;326:594–9.
Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 1984;10:185–92.
Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Binnendijk B. The prevention of superinfection in multiple trauma patients. J Antimicrob Chemother 1984;14 Suppl B:203–11.
Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Langrehr D. The effect of oropharyngeal decontamination using topical non absorbable antibiotics on the incidence of nosocomial respiratory tract infection in multiple trauma patients. J Trauma 1987;27(4):357–64.
Zandstra DF, Stoutenbeek CP, van Saene HKF, Bams JL. Selective decontamination of the digestive tract improves survival in patients receiving differential lung ventilation. Intensive Care Med 1988;15:15–8.
Van Saene HKF, Stoutenbeek CP, Stoller JK. Selective decontamination of the digestive tract in the intensive care unit: current status and future prospects. Crit Care Med 1992;20:691–703.
Stoutenbeek CP, van Saene HKF. Prevention of pneumonia by selective decontamination of the digestive tract (SDD). Intensive Care Med 1992;18:18–23.
Kerver AJH, Rommes JH, Mevissen-Verhage EAE. Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 1988;16:1087–93.
Ulrich C, Harinck de Weerd JE, Bakker NC, Jacz K, Doornbos L, de Ridder VA. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989;15:424–31.
Ledingham A, Alcock SR, Eastaway AT. Triple regimen of selective decontamination of the digestive tract. Systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1988;1:785–90.
Cockerill FR, Muller SR, Anhalt JP, Marsh HM, Farnell MB, Mucha P, et al. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 1992;117:545–53.
Cerra FB, Maddaus MA, Dumm DL, Wells CL, Konstantinides NN, Lehman SL, Mann HJ. Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg 1992;127:163–9.
Stoutenbeek CP, van Saene HKF, Zandstra DF. The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother 1987;19:513–20.
Brun-Buisson C, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, et al. Intestinal decontamination for control of nosocomial multiresistant Gram-negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med 1989;110:873–81.
Hammond JMJ, Potgieter PD, Saunders GL, Forder AA. Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992;340:5–9.
Alcock SR. Short-term parenteral antibiotics used as a supplement to SDD regimens. Infection 1990;18:4–8.
Winter R, Humphreys H, Pick A, MacGowan AP, Willats SM, Speller DCE. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother 1992;30:73–87.
Kaufhold A, Behrendt W, Kräuss T, van Saene H. Selective decontamination of the digestive tract and methicillinresistantStaphylococcus aureus. Lancet 1992;339:1411–2.
Craven DE, Daschner FD. Nosocomial pneumonia in the intubated patients: role of gastric colonization. Eur J Clin Microbiol Infect Dis 1989;8:40–50.
Johanson WG, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. Ann Intern Med 1972;77:701–6.
Van Uffelen R, Rommes JH, van Saene HKF. Preventing lower airway colonization and infection in mechanically ventilated patients. Crit Care Med 1987;15:99–102.
Bartlett JG, O'Keefe P, Tally FP, Louie TJ, Gorbach SL. Bacteriology of hospital-acquired pneumonia. Arch Intern Med 1986;146:868–71.
Du Moulin GC, Paterson DG, Hedley-Whyte J, Lisbon A. Aspiration of gastric bacteria in anti-acid treated patients: a frequent cause of post-operative colonization of the airway. Lancet 1982;1:242–5.
Hartenauer U, Thülig B, Lawin P, Fegeler W. Infection surveillance and selective decontamination of the digestive tract (SDD) in critically ill patients. Results of a controlled study. Infection 1990;18 Suppl 1:22–30.
Armstrong PJ, Barr JG, Webb CH, Blair PH, Rowlands BJ. Epidemiology ofPseudomonas aeruginosa in an intensive care unit using decontamination of the digestive tract. J Hosp Infect 1992;20:199–208.
Korinek AM, Laisne MJ, Nicolas MH, Raskine L, Deroin V, Sanson-Lepors MJ. Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study. Crit Care Med 1993;21:1466–73.
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Langlois-Karaga, A., Bues-Charbit, M., Davignon, A. et al. Selective digestive decontamination in multiple trauma patients: Cost and efficacy. Pharm World Sci 17, 12–16 (1995). https://doi.org/10.1007/BF01875552
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DOI: https://doi.org/10.1007/BF01875552