Infection control · Selective decontamination
Decontamination of the digestive tract and oropharynx in ICU patients
| Design | Cluster-randomised crossover trial |
|---|---|
| Treatment | Selective decontamination of the digestive tract (SDD), or selective oropharyngeal decontamination (SOD) |
| Control | Standard care |
| Population | 5939 ICU patients: 1990 standard care, 1904 SOD, 2045 SDD |
| Follow-up | 28 days |
| Primary endpoint | 28-day mortality |
| Result | Crude 28-day mortality was 27.5% with standard care, 26.6% with SOD and 26.9% with SDD. After adjustment, mortality was reduced by an estimated 3.5 percentage points with SDD and 2.9 percentage points with SOD. |
| Secondary endpoints | Bacteraemia, antibiotic resistance, ICU length of stay |
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.
The trial authors, in the published abstract
Persuasive in the Netherlands and never adopted widely elsewhere, because the benefit depends on a low background prevalence of resistant organisms. SuDDICU later tested it internationally and found nothing, which largely settles the question outside that setting.
de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009 Jan 1;360(1):20-31.