In previous studies, the impact of selective decontamination of the gastrointestinal tract and the oropharyngeal region on survival and prevention of bacteremia in ICU patients was assessed. The aim of an open, randomized, clustered cross-sectional study was to evaluate the effectiveness of these interventions in ICU patients to prevent colonization of the respiratory tract and the development of bacteremia caused by strains of very microorganisms. resistant.

Between May 2004 and July 2006, 13 intensive care units participated in the study in the Netherlands. Study participants were intensive care patients who required mechanical ventilation for more than 48 hours or who remained in intensive care for more than 72 hours. Patients were randomized to multiple treatment groups. The first group included patients who received selective oropharyngeal decontamination with tobramycin, colistin and amphotericin B, the second group included selective decontamination of the gastrointestinal tract with the drugs listed above with additional intravenous administration of cefotaxime for 4 days, and the third patient (control) with standard tact. Researchers calculated odds ratios (95% confidence interval) for the frequency of bacteremia or colonization of the respiratory tract by highly resistant strains of microorganisms in patients treated for intensive care for more than three days (i.e. it was a nosocomial infection).

Of 5939 patients, information on 5927 (more than 99%) was available for analysis, of which 5463 patients (92%) were in intensive care for more than three days. 239 (13%) of participants in the 1837 study in the standard management group had bacteremia after three days, compared to 158 (9%) of 1758 patients with selective oropharyngeal decontamination (odds ratio 0.66, confidence interval (CI) ) 95%)) 0.53-0.82) and 124 (7%) of 1868 patients who received selective gastrointestinal decontamination (odds ratio 0.48, 95% CI 0.38-0, 60). In 8 patients who underwent selective gastrointestinal decontamination, the bacteremia was caused by very resistant strains, against 18 patients (19 episodes of bacteremia in total) who received standard treatment (odds ratio 0.41, 95% CI 0.18-0.94; decrease in frequency 59%, reduction in absolute risk 0.6%) and 20 patients in the selective oropharyngeal decontamination group (odds ratio 0.37, 95% CI 0.16-0.85 ; frequency reduction 63%, reduction in absolute risk 0.7%). For patients who were in intensive care for more than 3 days, endotracheal aspiration for microbiological examination was obtained in 881 patients (49%) of the group of patients receiving standard treatment, in 886 (50%) patients receiving a selective oropharyngeal decontamination and in 828 (44%) patients who had undergone selective decontamination of the gastrointestinal tract.

In 128 (15%) patients in the standard treatment group, colonization with highly resistant strains was observed against 74 (8%) in the selective gastrointestinal decontamination group (odds ratio 0.58, 95% CI 0.43 -0.78; reduction in frequency 38%, a decrease in absolute risk of 5.5%) and 88 (10%) in the group for selective decontamination of the oropharyngeal region (odds ratio 0.65, 95% CI 0, 49-0.87; decrease in frequency 32%, decrease in absolute risk 4.6%). Acquired colonization of the respiratory tract by Gram-negative microorganisms, as well as pathogens resistant to cefotaxime and colistin, was the lowest of the group of patients receiving selective gastrointestinal decontamination.

The study limitations were insignificant differences in the initial characteristics of the study groups, in particular, patients in a more severe condition received selective oropharyngeal decontamination and selective gastrointestinal decontamination compared to patients who underwent treatment standard.

Thus, the prophylactic use of antibacterial drugs in intensive care considerably reduces the risk of infection in patients with intensive care caused by strains of antibiotic resistant microorganisms.