Effect of selective digestive decontamination on the nosocomial infection and multiresistant microorganisms incidence in critically ill patients

Ventilator-associated pneumonia (VAP) is a common complication in mechanically ventilated patients. Other infections related to the use of invasive devices, such urinary tract infections (UTI) and central venous catheter-related bloodstream infections are found in patients admitted in intensive care units (ICU). Selective digestive decontamination (SDD) is a set of manoeuvres (hygiene, topic digestive antimicrobials and short course of systemic antibiotics) aimed at decreasing the incidence of nosocomial infections, mainly VAP, in ICU. The objective of this study was to describe the impact of SDD in the rates of nosocomial infections in an 18-bed medical-surgical ICU. All patients admitted in the ICU from October 1998 to September 1999 with expected mechanical ventilation for at least 72 h or with an illness where SDD has proven to be efficacious. The infection rates during this period were compared with the infection rates of the period without SDD (October 1997 to September 1998). VAP rates decreased from 12.38 to 3.64 per 1000 days of mechanical ventilation (RR 0.3; CI 95%: 0.16 to 0.53). Urinary tract infection rates decreased form 7.70 to 4.51 per 1000 bladder-catheter days (RR 0.6. CI 95%: 0.37 to 0.93). Central venous catheter related bloodstream infections decreased from 5.92 to 2.73 per 1000 catheter days (RR: 0.5. CI 95%: 0.24 to 0.90). There was no emergence of resistant microorganims when SDD was used. SDD reduces infection rates in ICU without any significant adverse events.