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Related Experiment Videos

Intestinal decontamination in a polyvalent ICU. A double-blind study.

J Godard1, C Guillaume, M E Reverdy

  • 1Service de Réanimation, Hôpital Edouard Herriot, Lyon, France.

Intensive Care Medicine
|January 1, 1990
PubMed
Summary

Selective digestive decontamination did not reduce overall nosocomial infections but effectively lowered ICU-acquired infections, particularly Gram-negative types. This prevention strategy also delayed infection onset and decreased pneumonia incidence in intensive care units.

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Nosocomial infections pose a significant threat in intensive care units (ICUs).
  • Selective digestive decontamination (SDD) is a strategy to prevent infections by targeting microbial colonization in the gastrointestinal tract.

Purpose of the Study:

  • To evaluate the efficacy of selective digestive decontamination in preventing nosocomial infections within an ICU setting.
  • To assess the impact of SDD on ICU-acquired infections, specific infection types, infection onset, and patient outcomes.

Main Methods:

  • A double-blind, placebo-controlled trial was conducted in an ICU.
  • Patients received either a placebo or a regimen including tobramycin, colistin, and amphotericin B via gastric tube.
  • Intestinal decontamination or placebo was administered alternatively to patients in two ICU subunits over defined periods.

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Main Results:

  • SDD did not significantly reduce the overall number of infected patients (26% vs 34.5%).
  • However, SDD significantly decreased ICU-acquired infections (0.33 vs 0.60) and Gram-negative infection rates (0.17 vs 0.43).
  • The onset of the first ICU-acquired infection was delayed (9 vs 13 days), and pneumonia incidence, including bacterial pneumonia, was significantly reduced.

Conclusions:

  • Selective digestive decontamination alone is not effective in reducing overall nosocomial infections.
  • SDD demonstrates efficacy in reducing ICU-acquired infections, particularly Gram-negative infections, and delaying infection onset.
  • While SDD impacts infection rates, it did not significantly alter mean ICU stay or mortality.