Effectiveness and Cost of Selective Decontamination of the Digestive Tract in Critically Ill Intubated Patients: A Randomized, Double-blind, Placebo-controlled, Multicenter Trial

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11. 4% of SDD-treated and 29. 3% of control-group patients (p < 0. 001; 95% confidence interval CI: 7. 8 to 27. 9). The incidence of nonrespiratory infections in the two groups was 19. 1% and 30. 7%, respectively (p = 0. 04; 95% CI: 0. 7 to 22. 7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21. 5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0. 006). Mean cost per survivor was 11, 926 for treated and 16, 296 for control-group patients. Mortality was 38. 9% and 47. 1%, respectively (p = 0. 57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47. 4% to 13. 0% (p < 0. 001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.