The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients |
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Authors: | C P Stoutenbeek H K F van Saene D R Miranda D F Zandstra |
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Institution: | (1) Institute for Anesthesiology and Intensive Care, University of Groningen, Groningen, The Netherlands;(2) Department of Clinical Bacteriology, University of Groningen, Groningen, The Netherlands |
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Abstract: | 122 multiple trauma patients staying in the ICU for 5 or more days and needing mechanical ventilation were investigated to
determine the effect of selective decontamination of the digestive tract on prevention of infection. The (retrospectively
studied) control group of 59 patients received no antibiotic prophylaxis. The infection rate during ICU-stay was 81%. Most
infections were caused by potentially pathogenic microorganisms (PPM) from the oral cavity or the intestines (i.e. endogenous
infections). The oropharynx and the intestines were rapidly colonised with ICU-associated gram-negative bacilli. After 2 weeks
more than 80% of patients were found colonised. This secondary colonisation of the digestive tract is a very important stage
in the pathogenesis of infections. Sixty-three patients were selectively decontaminated with nonabsorbable antibiotics, administered
through the gastric tube even if peristalsis was absent. Emphasis was laid on the selective decontamination of the oral cavity,
using topical application of an antibiotic paste. With this technique the oral cavity was free of PPM within 3 days in most
patients. No secondary colonisation was found. Rectal colonisation decreased significantly after 5 days. Secondary colonisation
occurred in 9 patients with PPM sensitive to the antibiotics used. The prophylactic regimen included systemic cefotaxim, directed
against early endogenous infection. The suppression and after some time the absence of the endogenous source of PPM resulted
in a significant reduction of colonisation and infection. The total infection rate decreased to 16%. |
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Keywords: | Selective decontamination of the digestive tract (SDD) Multiple trauma Infection Colonisation Endogenous Prevention |
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