Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients
F. B. Cerra, M. A. Maddaus, D. L. Dunn, C. L. Wells, N. N. Konstantinides, S. L. Lehmann and H. J. Mann
Department of Surgery, School of Medicine, University of Minnesota, Minneapolis.
Suppression of the gut luminal aerobic flora to reduce nosocomial
infections was tested in a prospective, randomized, double-blind,
placebo-controlled clinical trial in patients in a surgical intensive care
unit who had persistent hypermetabolism. Forty-six patients were randomized
to receive either norfloxacin, 500-mg suspension every 8 hours, together
with nystatin, 1 million units every 6 hours, or matching placebo solutions
administered through a nasogastric tube within 48 hours of surgical
intensive care unit admission. Selective gut decontamination with the
experimental therapy or placebo solutions continued for at least 5 days or
until the time of surgical intensive care unit discharge. Patients were
monitored with routine surveillance cultures for the development of
nosocomial infections, as defined by criteria from the Centers for Disease
Control. All other therapy was given as clinically indicated, including
systemic antibiotics. The selective gut decontamination group experienced a
significant reduction in the incidence of nosocomial infections and a
reduced length of stay. However, these results were not associated with a
concomitant decrease in progressive multiple organ failure syndrome, adult
respiratory distress syndrome, or mortality.
