Infections acquired in hospital are a major cause of illness and death for patients and markedly increase health care costs. Critically ill patients are particularly susceptible to these infections and do very poorly if they acquire them. One intervention that has gained much interest in the medical literature for reducing infection rates and deaths from hospital acquired infections is selective decontamination of the digestive tract (SDD). SDD involves the application of antibiotic pastes to the mouth, throat and stomach and a short course of antibiotics into a vein. The evidence supporting the use of SDD for saving lives and preventing infections is quite strong, with 36 randomised controlled trials in the medical literature. Health care professionals in many parts of the world have held back from using SDD, possibly due to fears of the effects of overuse of antibiotics on the frequency of infections with resistant microorganisms such as “MRSA” and “Clostridium difficile”.
We have just completed a multi-national research study designed to understand why SDD has not been more fully implemented into practice. The results of this study make it clear that doctors will not implement SDD unless there is more high quality evidence to support the effectiveness of SDD in countries with higher rates of hospital acquired infections. It also demonstrates that clinicians also require a greater understanding of the effects of the widespread use of antibiotics on long-term antibiotic resistance and hospital acquired infection rates.
In this study we plan to undertake 1. a large-scale multi-national randomized trial of SDD on the number of patients who die or suffer severe infections in critical care units with 2. a study looking at the incidence, nature and outcomes from these infections as well as antibiotic resistance patterns in participating units, and 3. a formal assessment of the economics of using this treatment in practice.
If the benefits of this treatment are realized the results of this study could have a huge impact in terms of lives saved and infections prevented as well as making large saving in health care systems resource utilisation.
Current status
We are currently developing the full randomised controlled trial with accompanying ecology study and cost-effectiveness analysis with the intention to submit the project for funding consideration in 2013
References
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de Smet AMGA, Kluytmans JAJW, Cooper BS, Mascini EM, Benus RFJ, van der Werf TS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N. Engl. J. Med. 2009Jan.1;360(1):20–31.
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Cuthbertson BH, Francis J, Campbell MK, MacIntyre L, Seppelt I, Grimshaw J, et al. A study of the perceived risks, benefits and barriers to the use of SDD in adult critical care units (the SuDDICU study). Trials. 2010;11:117.
Brian Cuthbertson, Deborah Cook, Geoff Bellingan, Marion Campbell, Nick Daneman, Josh Davies, Jill Francis, Niall Ferguson, Simon Finfer, David Gattas, Parisa Glass, Anthony Gordon, John Iredell, Stephan Jan
Lynn Johnston, Salman Kanji, Andrea Marshall, John Marshall, John Myburgh, John Norrie, Kathy Rowan, Louise Rose, Alison MacDonald, Graeme MacLennan, Jason Roberts, Ian Seppelt, Rob Shulman, Charles Weijer, Peter Wilson