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Selective digestive decontamination in multiple trauma patients: cost and efficacy

A Langlois-Karaga1, M Bues-Charbit, A Davignon

  • 1Hôpital Nord, Chemin des Bourelly, Marseille, France.

Pharmacy World & Science : PWS
|January 27, 1995
PubMed

Insights

Selective digestive decontamination (SDD) reduced nosocomial pneumonia in trauma patients and cut drug costs by 41%. However, it increased methicillin-resistant Staphylococcus epidermidis.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Surgical Infections

Background:

  • Nosocomial pneumonia is a significant complication in multiple-trauma patients.
  • Preventive strategies are crucial to reduce infection rates and improve patient outcomes.
  • Selective digestive decontamination (SDD) is a potential method for infection prevention.

Purpose of the Study:

  • To evaluate the efficacy of SDD in preventing nosocomial pneumonia in multiple-trauma patients.
  • To assess the cost-effectiveness of SDD regarding drug expenditure.
  • To identify the impact of SDD on the spectrum of infectious agents, including resistant strains.

Main Methods:

  • A double-blind, randomized, placebo-controlled study design.
  • Inclusion of multiple-trauma patients requiring intensive care.
  • Administration of SDD or placebo, with monitoring for nosocomial infections and antibiotic use.

Main Results:

  • Nosocomial infections, particularly pneumonia, were significantly less frequent in the SDD group compared to the placebo group.
  • While Staphylococcus aureus was more common in the placebo group, Staphylococcus epidermidis predominated in the SDD group.
  • The SDD group showed an increase in methicillin-resistant Staphylococcus epidermidis, but no methicillin-resistant Staphylococcus aureus was detected.
  • Patients in the SDD group required less antibiotherapy, leading to approximately 41% savings in drug expenditure.

Conclusions:

  • SDD is effective in reducing nosocomial pneumonia and associated antibiotic use in multiple-trauma patients.
  • SDD offers significant cost savings in drug expenditure.
  • Surveillance for resistant organisms like MRSE is important during SDD implementation.

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