Neurologic disease requiring long-term ventilation. The role of selective decontamination of the digestive tract in preventing nosocomial infection.

STUDY OBJECTIVE

To evaluate the efficacy of the technique of selective decontamination of the digestive tract (SDD) in preventing secondary infections in patients with neurologic diseases requiring intensive care.

DESIGN

Randomized, double-blind, placebo-controlled trial using amphotericin B, polymyxin E, and tobramycin applied to the oropharynx and enterally; all patients received intravenous cefotaxime for 72 h.

SETTING

Respiratory ICU.

PATIENTS

Forty patients with neurologic diseases requiring ventilation for > 48 h and ICU stay > 5 days. Neurologic diagnosis included acute inflammatory demyelinating neuropathy (15), meningoencephalitis (10), status epilepticus (6), tetanus (6), and myasthenia gravis (3).

INTERVENTIONS

Microbiologic surveillance samples of oropharyngeal and tracheal secretions, gastric aspirates, stool, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until 3 days after discharge from the unit. The SDD was applied every 6 h to the oropharynx and enterally.

MEASUREMENTS AND RESULTS

Effective decontamination of the gastrointestinal tract was achieved in the patients receiving the active regimen; however, there was no reduction in the incidence of infections (11 in the active group vs 10 in placebo), and duration of ICU stay (30.1 +/- 22.5 vs 20.6 +/- 17.7 days) and hospital stay (49.3 +/- 31.9 vs 40 +/- 33.4 days) were unaffected as was the mortality (15 percent vs 15 percent).

CONCLUSIONS

SDD did not reduce the incidence of secondary infection in patients with neurologic disease, nor did it affect morbidity or mortality; however, it adds considerably to the cost of patient care.