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Selective Gut Decontamination Reduces Nosocomial Infections and Length of Stay but Not Mortality or Organ Failure in Surgical Intensive Care Unit Patients
Frank B. Cerra, MD;
Mike A. Maddaus, MD;
David L. Dunn, MD, PhD;
Carol L. Wells, PhD;
Nancy N. Konstantinides, RN, MS;
Sharon L. Lehmann, RN, MS;
Henry J. Mann, PharmD
Arch Surg. 1992;127(2):163-169.
Abstract
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• 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.
(Arch Surg. 1992;127:163-169)
Author Affiliations
From the Departments of Surgery (Drs Cerra, Maddaus, and Dunn) and Laboratory Medicine and Pathology (Dr Wells), School of Medicine, the College of Pharmacy (Dr Mann), University of Minnesota, Minneapolis, and the Department of Surgery, the University of Michigan, Ann Arbor (Mss Konstantinides and Lehmann).
Footnotes
Accepted for publication September 8, 1991.
Presented at the 11th Annual Meeting of the Surgical Infection Society, Fort Lauderdale, Fla, April 9, 1991.
Reprint requests to University of Minnesota Hospital and Clinic, Box 42 UMHC, 406 Harvard St SE, Minneapolis, MN 55455 (Dr Cerra).
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