[A clinical study of selective gut decolonization in 204 long-term ventilated intensive care patients undergoing abdominal and accident surgery]

Abstract

In a randomized clinical trial the effects of selective digestive decolonization (SDD) on the frequency of pneumonia and sepsis and the rate of lethality as well as the resistance quota and colonization of bacteria were studied in 102 surgical ICU-patients requiring prolonged mechanical ventilation. These patients received non-resorbable antibiotics: 4 x 100 mg of polymyxin B, 4 x 500 mg of amphotericin B, and 4 x 80 mg of tobramycin via gastric tube. One hundred and two patients served as controls. Patients with an expected period of mechanical ventilation of more than 4 days were included into the study. In both groups there were no significant differences regarding the degree of severity of the primary disease. The rate of pneumonia in the SDD-group was significantly lower after the third day compared with the frequency in the control group. The rate of sepsis was significantly lower after the thirteenth day, and the survival rate in the SDD-group was significantly higher after the twenty-fourth day of artificial ventilation compared with the control group. A significant reduction of the incidence of potential pathogenic gram-negative aerobe germs detected bronchially and rectally could be demonstrated within the first week in patients of the SDD-group. A secondary colonization of the oropharynx in patients of the SDD-group could not be observed. 38.8% of the patients in the control group showed potentially pathogenic microorganisms in oropharyngeal swabs. A development of resistance of pseudomonas aeruginosa against tobramycin occurred in 2.3% of the patients in the SDD-group and in 3.1% of the patients in the control group. It can be concluded that the administration of non-resorbable antimicrobials against gram-negative aerobes is an effective method for prevention of potentially fatal pneumonia and sepsis, and for the first time a significant improvement of the survival rate could be demonstrated.