Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU

H A Tissot van Patot; J A Leusink; J Roodenburg; B M de Jongh; H S Lau; S de Boer; A de Boer

doi:10.1007/BF00820728

Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU

H A Tissot van Patot, J A Leusink, J Roodenburg, B M de Jongh, H S Lau, S de Boer, A de Boer

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.

OBJECTIVE: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.

DESIGN: Retro- and prospective follow-up.

PATIENTS: Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.

RESULTS: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).

CONCLUSION: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.

Original language	English
Pages (from-to)	171-177
Number of pages	7
Journal	Pharmacy World & Science
Volume	18
Issue number	5
DOIs	https://doi.org/10.1007/BF00820728
Publication status	Published - 1996

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Child
Cross Infection
Digestive System
Female
Follow-Up Studies
Gram-Negative Bacterial Infections
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Postoperative Care
Prospective Studies
Retrospective Studies
Ventilators, Mechanical

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10.1007/BF00820728

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@article{f0481e1dd4084687ae2a0678c2867820,

title = "Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU",

abstract = "BACKGROUND: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.OBJECTIVE: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.DESIGN: Retro- and prospective follow-up.PATIENTS: Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.RESULTS: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).CONCLUSION: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Child, Cross Infection, Digestive System, Female, Follow-Up Studies, Gram-Negative Bacterial Infections, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Postoperative Care, Prospective Studies, Retrospective Studies, Ventilators, Mechanical",

author = "{Tissot van Patot}, {H A} and Leusink, {J A} and J Roodenburg and {de Jongh}, {B M} and Lau, {H S} and {de Boer}, S and {de Boer}, A",

year = "1996",

doi = "10.1007/BF00820728",

language = "English",

volume = "18",

pages = "171--177",

journal = "Pharmacy World & Science",

issn = "0928-1231",

publisher = "Kluwer Academic Publishers, UK",

number = "5",

}

TY - JOUR

T1 - Selective decontamination of the digestive tract

T2 - effect of cessation of routine application at an ICU

AU - Tissot van Patot, H A

AU - Leusink, J A

AU - Roodenburg, J

AU - de Jongh, B M

AU - Lau, H S

AU - de Boer, S

AU - de Boer, A

PY - 1996

Y1 - 1996

N2 - BACKGROUND: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.OBJECTIVE: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.DESIGN: Retro- and prospective follow-up.PATIENTS: Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.RESULTS: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).CONCLUSION: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.

AB - BACKGROUND: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.OBJECTIVE: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.DESIGN: Retro- and prospective follow-up.PATIENTS: Post-operative patients with mechanical ventilation (MV) for > or = 5 days at an ICU were included. The retrospective group (SDD group) comprised of 138 patients (mean age 66, range 10-91; 78% male) and the prospective group (non-SDD group) of 142 patients (mean age 67 range 18-85; 65% male). The SDD regime consisted of colistin, tobramycin and amphotericin B. Cessation of the SDD was accompanied by a shortening of the routine intravenous cefuroxime prophylaxis.RESULTS: There was a nonsignificant increase from an average 21 to 23 days ICU stay in the non-SDD group when compared with the SDD group (p > 0.05). Of the 280 patients 97 (35%) died on the ICU. The risk of death was lower in the non-SDD group (adjusted hazard ratio 0.7 with 95% Cl 0.5-1.1). There was a trend towards an increase in infections as a cause of death in the non-SDD group (38% of the ceased patients versus 20% in the SDD group) (p > 0.05). The incidence of respiratory tract infection (per 1000 person days) was 80 (95% Cl 48-113) in the non-SDD group versus 19 (95% Cl 8-22) in the SDD group (adjusted hazard ratio 4.5 (95% Cl 2.9-7.1)).CONCLUSION: The cessation of the routine application of SDD in post-operative patients mechanically ventilated for 5 days or more did nod adversely affect survival nor increased length of stay at the ICU. There may have been a shift to infections as a cause of death after cessation of SDD.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents

KW - Child

KW - Cross Infection

KW - Digestive System

KW - Female

KW - Follow-Up Studies

KW - Gram-Negative Bacterial Infections

KW - Humans

KW - Intensive Care Units

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Postoperative Care

KW - Prospective Studies

KW - Retrospective Studies

KW - Ventilators, Mechanical

U2 - 10.1007/BF00820728

DO - 10.1007/BF00820728

M3 - Article

C2 - 8933577

SN - 0928-1231

VL - 18

SP - 171

EP - 177

JO - Pharmacy World & Science

JF - Pharmacy World & Science

IS - 5

ER -

Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU

Abstract

Keywords

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