Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 20 May 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Decontamination of the digestive tract in intensive care patients

The latest issue of the New England Journal of Medicine examines decontamination of the digestive tract and oropharynx in intensive care unit patients.

News image

fiogf49gjkf04

Selective digestive tract decontamination and selective oropharyngeal decontamination are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting.

Dr de Smet and colleagues from the Netherlands evaluated the effectiveness of selective digestive tract decontamination and selective oropharyngeal decontamination in a crossover study using cluster randomization in 13 intensive care units.

 

Patients with an expected duration of intubation of more than 48 hours or an expected intensive care unit stay of more than 72 hours were eligible.

 

In each intensive care unit, 3 regimens were applied in random order over the course of 6 months.

 

The 3 regimens included selective digestive tract decontamination, selective oropharyngeal decontamination, and standard care.

 

Mortality at day 28 was the primary end point.

 

Crude mortality at day 28 with standard care was 28%

New England Journal of Medicine
Selective digestive tract decontamination consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach.

 

Selective oropharyngeal decontamination consisted of oropharyngeal application only of the same antibiotics.

 

The research team performed monthly point-prevalence studies to analyze antibiotic resistance.

 

A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to selective oropharyngeal decontamination, and 2045 to selective digestive tract decontamination.

 

The team noted that crude mortality in the groups at day 28 was 28%, 27%, and 26%, respectively.

 

The team used a random-effects logistic-regression model using age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates,

 

The odds ratios for death at day 28 in the selective oropharyngeal decontamination and selective digestive tract decontamination, as compared with the standard-care group, were 0.9 and 0.8, respectively.

 

Dr de Smet’s team concludes, “In an intensive care unit population in which the mortality rate associated with standard care was 28% at day 28, the rate was reduced by an estimated 4% with selective digestive tract decontamination 3% with selective oropharyngeal decontamination.”  

NEJM 2008: 360(1): 20-31
06 January 2009

Go to top of page Email this page Email this page to a colleague

 18 May 2018 
Esophageal dilatation in clinical practice 
 17 May 2018 
IBD and later extraintestinal manifestations
 17 May 2018 
Repeat stool DNA testing
 17 May 2018 
IBS and chronic fatigue following GI infection
 16 May 2018 
Factors associated with fecal incontinence
 16 May 2018 
Diagnostic delay in Crohn's disease
 16 May 2018 
Cardiovascular risk in diabetes mellitus with NAFLD
 15 May 2018 
Guidelines for management of Crohn's
 15 May 2018 
Hep B in the Grey Zone
 15 May 2018 
New therapies for CDI
 14 May 2018 
Blood test for the diagnosis of fibrotic NASH
 14 May 2018 
Outcomes at bariatric centers of excellence
 14 May 2018 
Management of perianal fistulas in Crohn’s
 11 May 2018 
Detection of undiagnosed celiac disease
 11 May 2018 
Alcohol consumption and drug-induced liver injury
 11 May 2018 
Depressive symptoms in IBD youth
 10 May 2018 
Post‐operative complications in elderly IBD
 10 May 2018 
Colorectal cancer screening
 10 May 2018 
Fibrosis in patients with chronic hepatitis B
 09 May 2018 
Fecal incontinence
 09 May 2018 
Health problems and IBS
 09 May 2018 
Esophageal dilatation in clinical practice 
 07 May 2018 
Omitting antibiotics in uncomplicated acute diverticulitis
 07 May 2018 
Health problems and IBS
 07 May 2018 
Assessment of diminutive colorectal polyps
 04 May 2018 
Factors associated with fecal incontinence
 04 May 2018 
National Institutes of Health workshop and obesity
 04 May 2018 
Colorectal cancer screening and ethnic inequities
 03 May 2018 
Gastrointestinal ultrasound in IBD
 03 May 2018 
PPI use and cognitive decline
 03 May 2018 
Ultransonography in postsurgical recurrence in Crohn's
 02 May 2018 
Symptom assessment in cirrhotic ascites
 02 May 2018 
Hep C antiviral treatment and liver cancer risk
 02 May 2018 
Chronic Hep B
 01 May 2018 
European guidelines on pancreatic cystic neoplasms
 01 May 2018 
Interferon‐free regimens in Hep C
 01 May 2018 
Age at IBD onset and extraintestinal complications
 30 April 2018 
Formula for preterm infants
 30 April 2018 
Primary antibiotic resistance and sequential therapy for H. pylori
 30 April 2018 
Patient-reported outcome measures in IBD trials
 27 April 2018 
Anxiety scale for chronic esophageal disease
 27 April 2018 
Disease activity in eosinophilic esophagitis
 27 April 2018 
Eastern and western practices for endoscopic resection of colorectal lesions
 26 April 2018 
Obesity and physical activity in diverticulosis
 26 April 2018 
Fecal incontinence and quality of life in IBD
 26 April 2018 
Primary sclerosing cholangitis in the USA
 25 April 2018 
Aspirin and pancreatic cancer
 25 April 2018 
Central mediators of irinotecan-induced steatohepatitis
 25 April 2018 
Neuroimaging in Hep C
 24 April 2018 
Scoring system identifies cancer risk in Barrett's
 24 April 2018 
Microbiome in athletes vs sedentary subjects
 24 April 2018 
PPI and risk of stroke
 23 April 2018 
Genome-wide study on HBV-related acute-on-chronic liver failure
 23 April 2018 
Antibody suitable for further clinical development to complement existing therapeutic strategies for HCV
 23 April 2018 
Sleep deprivation and NAFLD in the USA
 20 April 2018 
Two annexin A11 epitopes targeted by IgG1 and IgG4 autoantibodies were shared between patients with IAC/AIP and IgG4 antibodies blocked binding of IgG1 antibodies to the shared annexin A11 epitopes
 20 April 2018 
Adalimumab with azathioprine in Crohn's
 20 April 2018 
Worldwide H.pylori prevalence
 19 April 2018 
c-Myc expression and pancreatic cancer
 19 April 2018 
Olmesartan prescription in the USA

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us