Cited by 813Nosocomial Infections in ICUSepsis Diagnosis and TreatmentAntifungal resistance and susceptibility

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Decontamination of the Digestive Tract and Oropharynx in ICU Patients

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de Smet, A.M.G.A., Kluytmans, J.A.J.W., Cooper, B.S., Mascini, E.M., Benus, R.F.J., van der Werf, T.S., van der Hoeven, J.G., Pickkers, P., Bogaers-Hofman, D., van der Meer, N.J.M., Bernards, A.T., Kuijper, E.J., Joore, J.C.A., Leverstein-van Hall, M.A., Bindels, A.J.G.H., Jansz, A.R., Wesselink, R.M.J., de Jongh, B.M., Dennesen, P.J.W., van Asselt, G.J., te Velde, L.F., Frenay, I.H.M.E., Kaasjager, K., Bosch, F.H., van Iterson, M., Thijsen, S.F.T., Kluge, G.H., Pauw, W., de Vries, J.W., Kaan, J.A., Arends, J.P., Aarts, L.P.H.J., Sturm, P.D.J., Harinck, H.I.J., Voss, A., Uijtendaal, E.V., Blok, H.E.M., Thieme Groen, E.S., Pouw, M.E., Kalkman, C.J., Bonten, M.J.M.·2009·New England Journal of Medicine

DOI 10.1056/nejmoa0800394

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Abstract

BACKGROUND: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS: We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS: A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS: In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)

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Authors: de Smet, A. M. G. A., Kluytmans, J. A. J. W., Cooper, B. S., Mascini, E. M., Benus, R. F. J., van der Werf, T. S., van der Hoeven, J. G., Pickkers, P., Bogaers-Hofman, D., van der Meer, N. J. M., Bernards, A. T., Kuijper, E. J., Joore, J. C. A., Leverstein-van Hall, M. A., Bindels, A. J. G. H., Jansz, A. R., Wesselink, R. M. J., de Jongh, B. M., Dennesen, P. J. W., van Asselt, G. J., te Velde, L. F., Frenay, I. H. M. E., Kaasjager, K., Bosch, F. H., van Iterson, M., Thijsen, S. F. T., Kluge, G. H., Pauw, W., de Vries, J. W., Kaan, J. A., Arends, J. P., Aarts, L. P. H. J., Sturm, P. D. J., Harinck, H. I. J., Voss, A., Uijtendaal, E. V., Blok, H. E. M., Thieme Groen, E. S., Pouw, M. E., Kalkman, C. J., & Bonten, M. J. M.
Affiliations: University Medical Center Utrecht (NL)
Amphia Ziekenhuis (NL)
Rijnstate Hospital (NL)
Utrecht University (NL)
Leiden University Medical Center (NL)
Diakonessenhuis hospital (NL)
Catharina Ziekenhuis (NL)
ORCID: de Smet, A.M.G.A.
Kluytmans, J.A.J.W.
Cooper, B.S.
van der Werf, T.S.
van der Hoeven, J.G.
Pickkers, P.
van der Meer, N.J.M.
Kuijper, E.J.
Dennesen, P.J.W.
Kaasjager, K.
Bosch, F.H.
Thijsen, S.F.T.
Kluge, G.H.
Sturm, P.D.J.
Uijtendaal, E.V.
Kalkman, C.J.
Bonten, M.J.M.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2009-01
Volume: 360
Issue: 1
Pages: 20-31
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa0800394
OpenAlex: W2065088137
Cited by: 813
References: 34
Citations by year: 2026: 12 · 2025: 22 · 2024: 16 · 2023: 30 · 2022: 32 · 2021: 39 · 2020: 36 · 2019: 29 · 2018: 39 · 2017: 48 · 2016: 45 · 2015: 61 · 2014: 52 · 2013: 62 · 2012: 68
FWCI: 59.40
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
Pure Amsterdam UMC (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Keywords: selective decontamination of the digestive tract, selective oropharyngeal decontamination, intensive care unit patients, nosocomial infection prevention, 28-day mortality, cefotaxime, tobramycin, colistin, amphotericin B, antibiotic resistance, intubation, critically ill patients
MeSH terms: Aged, Anti-Bacterial Agents, Cross Infection, Decontamination, Female, Gram-Negative Bacteria, Humans, Intensive Care Units, Male, Middle Aged, Oropharynx, Respiration, Artificial, Logistic Models, Bacteremia, Critical Illness, Infection Control, Cross-Over Studies, APACHE, Gastrointestinal Tract

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