The Liverpool Experience, 1987–1988

Abstract

Selective decontamination of the digestive tract (SDD), in combination with a short course of parenteral cefotaxime, was introduced in the ICU at the Royal Liverpool Hospital (RLH) in March 1987. The regimen was introduced on a routine basis without prior trial. The results presented here relate to the incidence of resistance among gram-negative isolates from colonized/infected sites of patients in the ICU. This is in no way meant to underestimate the role of gram-positive organisms in infection. After 18 months of use of SDD in combination with cefotaxime, there has been no statistically significant increase in gram-positive infections and, in particular, there has been no infection or colonization with highly resistant, potentially pathogenic gram-positive microorganisms (e.g. Streptococcus faecium). Among gram-negative isolates there has been no increase in resistance to cefotaxime in ICU compared to the overall hospital resistance rate for that drug, and resistance to aminoglycosides (in our case gentamicin) had not increased compared to the rate observed over the preceding 18 months.