Selective decontamination of digestive tract in intensive care

Abstract

Evert de Jonge and colleagues1de Jonge E Schultz MJ Spanjaard L et al.Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial.Lancet. 2003; 362: 1011-1016Summary Full Text Full Text PDF PubMed Scopus (498) Google Scholar found that SDD of patients in ICUs reduced mortality without increasing colonisation with resistant bacteria. These results contrast with those of previous reports: no other studies have shown a significant improvement in survival among SDD-treated patients.2Krueger WA Lenhart FP Neeser G et al.Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial.Am J Respir Crit Care Med. 2002; 166: 1029-1037Crossref PubMed Scopus (232) Google Scholar, 3Cockerill 3rd, FR Muller SR Anhalt JP et al.Prevention of infection in critically ill patients by selective decontamination of the digestive tract.Ann Intern Med. 1992; 117: 545-553Crossref PubMed Scopus (101) Google Scholar We would like to discuss some problems with the study. Our most significant concern is the open-label design of the study. Patients enrolled were admitted to one of two units, the SDD unit and the control unit, and medical staff did not mix between the two. de Jonge and colleagues selected objective endpoints such as inhospital mortality to keep bias to a minimum. However, unrecognised bias might have influenced the results of this study, considering the possible differences in ward environments and medical staff between the two treatment groups. The decrease in mortality in the SDD unit could also be explained by the possibility that SDD might have reduced bacterial or fungal infections. We would be interested to see detailed information on the ward environments, including incidence of nosocomial infections, patients' outcomes, and causes of death. Selective decontamination of digestive tract in intensive careAuthors' reply Full-Text PDF