Decontamination Reduces Death in Intensive Care Unit (click title to entry - thank you)
Antibiotic decontamination of digestive tract or oropharynx beneficial
Publish date: Jan 1, 2009
THURSDAY, Jan. 1 (HealthDay News) -- Decontaminating the digestive tract or the oropharynx with antibiotics to avoid infection reduces the likelihood of death in critically ill patients in the intensive care unit (ICU), according to an article in the Jan. 1 issue of the New England Journal of Medicine.
A.M.G.A. de Smet, M.D., from University Medical Center Utrecht in the Netherlands, and colleagues assigned 5,939 ICU patients to selective digestive tract decontamination (SDD, topical or intravenous administration of four antibiotics), selective oropharyngeal decontamination (SOD, oropharyngeal administration of the same antibiotics), or standard care. A cluster randomization design was used, where all patients received all three regimens in random order over the course of six months.
At day 28, the investigators found that crude mortality was 27.5 percent for the standard care group, 26.6 percent for the SOD group and 26.9 percent for the SDD group. Using a model that took age, sex, Acute Physiology and Chronic Health Evaluation score, intubation status, and medical specialty into account, the likelihood of death was significantly lower for both the SOD group (odds ratio 0.86) and SDD group (odds ratio 0.83) compared with the standard care group, the researchers report.
"These data show an absolute reduction in mortality of 3.5 and 2.9 percentage points (corresponding to relative reductions of 13 percent and 11 percent) at day 28 with SDD and SOD, respectively, among patients admitted to Dutch ICUs," de Smet and colleagues conclude. "Considering the importance of antibiotic resistance in ICUs, the SOD regimen seems preferable to the SDD regimen because it does not include widespread systemic prophylaxis with cephalosporins and involves a lower volume of topical antibiotics, thus minimizing the risk of selection for and development of antibiotic resistance in the long term."
Several of the study authors report financial relationships with the pharmaceutical industry.
