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Infection surveillance and selective decontamination of the digestive tract (SDD) in critically ill patients — results of a controlled study

Infektionsüberwachung und selektive Darmdekontamination (SDD) in der operativen Intensivmedizin — Ergebnisse einer kontrollierten prospektiven Studie

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Summary

All ICU patients were continuously monitored for infections according to a standard protocol by the physician in charge and an infection control nurse during the first quarter of five consecutive years (1980–1984). The number of patients surveyed was 1,009. The average age was 45.5 years and the average period of stay about four days. 733 patients (72.6%) were intubated and artificially ventilated for three days. A fatal outcome resulted in 13.2% of all patients. 1,129 nosocomial infections were registered in 331 patients, which means an infection rate of 32.8%. The most frequent nosocomial infections were those of the respiratory tract (24.3%). Wound infections developed in 16.6%. The urinary tract was affected in 8.8%. Nosocomial septicaemias were observed in 8.7%. Catheter-associated infections were found in 6.7% of the patients. A fatal outcome resulted in 26% of the patients with nosocomial infections and in 6.9% of the non-infected patients, respectively. There was no significant reduction in nosocomial infections over the five-year period in our ICU. Therefore, a study was designed to evaluate the concept of selective decontamination of the digestive tract (SDD) in critically ill patients in our two surgical/traumatological ICUs. A prospective, consecutive, placebo-controlled study in two ICUs was carried out during four six-month periods. 200 patients who were intubated for at least three days, required intensive care for a minimum of five days, and belonged to either class III or IV according to the “Therapeutic Intervention Scoring System” were included in the study. They received either placebo or a prophylaxis regimen, consisting of polymyxin E, tobramycin and amphotericin B. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. Selective flora suppression is effective in reducing infection rates in critically ill patients without development of resistant strains.

Zusammenfassung

Zur Dokumentation nosokomialer Infektionen auf einer Intensivstation wurden in einer täglichen gemeinsamen Infektionsvisite von Untersucher und Hygienefachschwester alle infektionsrelevanten Daten auf einem zuvor entwickelten Erhebungsbogen erfaßt. Ausgewertet wurden die jeweils ersten Quartale (Februar-April) der Jahre 1980–1984. Die Untersuchung schloß 1009 Patienten ein. Das mittlere Lebensalter betrug 45,5 Jahre, die mittlere Behandlungsdauer 3,9 Tage. 733 Patienten (72,6%) mußten während der Intensivtherapie im Mittel 3 Tage lang beatmet werden. Die Mortalität im gesamten Beobachtungszeitraum betrug 13,2%. Über den gesamten Zeitraum wurden insgesamt 1129 nosokomiale Infektionen (NI) bei 331 Patienten beobachtet. Das entsprach einer Infektionsrate von 32,8%. Die häufigsten registrierten Infektionen bezogen auf die Anzahl insgesamt infizierter Patienten waren bronchopulmonale (BPI)(24,3%), Wund- (WI) (16,6%) und Harnwegsinfektionen (HWI) (8,8%). Hinzu kamen Septikämien (SI) (8,7%) und mit intravasalen Kathetern assoziierte Infektionen (ZVI) (6,7%). Nosokomial infizierte verstarben viermal häufiger (26%) als nicht infizierte Patienten (6,9%). Während der 5jährigen Infektionsüberwachung konnten die Infektionsraten nicht signifikant reduziert werden. Daher wurde eine einjährige prospektive, konsekutive, plazebokontrollierte Studie auf zwei Intensivtherapiestationen (ICU) durchgeführt, mit der das Konzept der selektiven Florasuppression überprüft werden sollte. 200 Patienten erfüllten die Aufnahmekriterien (mindestens drei Tage Intubation und fünf Tage Intensivtherapie, Klasse III oder IV im „Therapeutic Intervention Scoring System“). Die Patienten erhielten entweder Plazebo oder Prophylaxeregime aus Polymyxin E, Tobramycin und Amphotericin B. Die Raten der Bronchopneumonien (ICU I und II) und Harnwegsinfektionen (ICU II) wurden signifikant reduziert. Wundinfektionen, Septikämien und Mortalität wurde nicht signifikant vermindert. Resistenzentwicklungen oder Zunahmen multiresistenter Stämme wurden nicht beobachtet. Damit stellt selektive Florasuppression ein hochwirksames Verfahren zur Infektionsprophylaxe in der operativen Intensivmedizin dar.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Str. 33, D-4400, Münster

    U. Hartenauer,  B. Thülig &  P. Lawin

  2. Institut für Medizinische Mikrobiologie, Westfälische Wilhelms-Universität Münster, Domagkstr. 10, D-4400, Münster, FR Germany

    W. Fegeler

Authors
  1. U. Hartenauer
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  2. B. Thülig
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  3. P. Lawin
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  4. W. Fegeler
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Hartenauer, U., Thülig, B., Lawin, P. et al. Infection surveillance and selective decontamination of the digestive tract (SDD) in critically ill patients — results of a controlled study. Infection 18 (Suppl 1), S22–S30 (1990). https://doi.org/10.1007/BF01644483

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