| Title: |
Effect of selective decontamination of the digestive tract on hospital mortality in critically Ill patients receiving mechanical ventilation a randomized clinical trial |
| Authors: |
Myburgh, JA; Seppelt, IM; Goodman, F; Billot, L; Correa, M; Davis, JS; Gordon, AC; Hammond, NE; Iredell, J; Li, Q; Micallef, S; Miller, J; Mysore, J; Taylor, C; Young, PJ; Cuthbertson, BH; Finfer, SR |
| Contributors: |
NIHR |
| Source: |
1921 ; 1911 |
| Publisher Information: |
American Medical Association |
| Publication Year: |
2022 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
Science & Technology; Life Sciences & Biomedicine; Medicine; General & Internal; General & Internal Medicine; INTENSIVE-CARE; ANTIBIOTIC-RESISTANCE; PREVENTION; OROPHARYNX; SDD; Female; Humans; Male; Middle Aged; Administration; Intravenous; Anti-Bacterial Agents; Bacteremia; Critical Illness; Cross Infection; Cross-Over Studies; Decontamination; Drug Resistance; Microbial; Gastrointestinal Tract; Hospital Mortality; Intensive Care Units; Pneumonia; Ventilator-Associated; Respiration |
| Description: |
Importance Whether selective decontamination of the digestive tract (SDD) reduces mortality in critically ill patients remains uncertain. Objective To determine whether SDD reduces in-hospital mortality in critically ill adults. Design, Setting, and Participants A cluster, crossover, randomized clinical trial that recruited 5982 mechanically ventilated adults from 19 intensive care units (ICUs) in Australia between April 2018 and May 2021 (final follow-up, August 2021). A contemporaneous ecological assessment recruited 8599 patients from participating ICUs between May 2017 and August 2021. Interventions ICUs were randomly assigned to adopt or not adopt a SDD strategy for 2 alternating 12-month periods, separated by a 3-month interperiod gap. Patients in the SDD group (n = 2791) received a 6-hourly application of an oral paste and administration of a gastric suspension containing colistin, tobramycin, and nystatin for the duration of mechanical ventilation, plus a 4-day course of an intravenous antibiotic with a suitable antimicrobial spectrum. Patients in the control group (n = 3191) received standard care. Main Outcomes and Measures The primary outcome was in-hospital mortality within 90 days. There were 8 secondary outcomes, including the proportion of patients with new positive blood cultures, antibiotic-resistant organisms (AROs), and Clostridioides difficile infections. For the ecological assessment, a noninferiority margin of 2% was prespecified for 3 outcomes including new cultures of AROs. Results Of 5982 patients (mean age, 58.3 years; 36.8% women) enrolled from 19 ICUs, all patients completed the trial. There were 753/2791 (27.0%) and 928/3191 (29.1%) in-hospital deaths in the SDD and standard care groups, respectively (mean difference, −1.7% [95% CI, −4.8% to 1.3%]; odds ratio, 0.91 [95% CI, 0.82-1.02]; P = .12). Of 8 prespecified secondary outcomes, 6 showed no significant differences. In the SDD vs standard care groups, 23.1% vs 34.6% had new ARO cultures (absolute difference, −11.0%; 95% CI, −14.7% ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
JAMA: Journal of the American Medical Association; http://hdl.handle.net/10044/1/101358 |
| DOI: |
10.1001/jama.2022.17927 |
| Availability: |
http://hdl.handle.net/10044/1/101358; https://doi.org/10.1001/jama.2022.17927 |
| Rights: |
© 2022 American Medical Association. All rights reserved. |
| Accession Number: |
edsbas.4FAEED80 |
| Database: |
BASE |