Prevention of Colonization and Subsequent Infection in Critically Ill Patients: a Prospective, Randomized Study

Abstract

The aim of this study was to determine whether it is possible to prevent colonization of the oropharynx and digestive tract with gram-negative bacteria and yeasts (important causal agents of morbidity and mortality in critically ill patients) and, if so, whether prevention of colonization results in a decrease in the infection rate of such patients. We evaluated patients (n = 96) admitted to the surgical ICU requiring intensive care for more than 5 days; most were trauma or post-surgery patients, all were mechanically ventilated, and all had indwelling catheters. All were examined daily for clinical signs of infection; haematological and biochemical data were collected daily, bacteriological surveillance cultures were taken thrice weekly. On admission, patients were randomly allocated to either a control group or a group receiving topically applied prophylactic agents (SDD): (1) a methyl-cellulose paste containing a 2% solution of tobramycin, polymyxin E and amphotericin B applied to the buccal mucosa four times daily; (2) a suspension of tobramycin 80 mg, polymyxin E 200 mg and amphotericin B 500 mg administered via nasogastric tube four times daily; (3) cefotaxime (50–70 mg/kg/day i.v.) for 5–7 days, until cultures of oropharynx and lower respiratory tract were negative.