Selective digestive decontamination in multiple trauma patients: cost and efficacy

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.