Does treating ICU patients with prophylactic antibiotics save lives? A study conducted in 13 Dutch hospitals suggests the answer to this controversial question is yes.
Researchers evaluated records on almost 6,000 patients who received ICU care in the Netherlands between 2004 and 2006. The patients studied were expected to be endotracheally intubated for more than 48 hours or expected to stay in the ICU for more than 72 hours. Patients received one of these three regimens:
* selective digestive tract decontamination (SDD): 4 days of I.V. cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and in the stomach (via gastric tube)
* selective oropharyngeal decontamination (SOD): oropharyngeal application only of the same antibiotics
* standard ICU care.
After 28 days, the risk of mortality associated with standard care was 27.5%. The rate was reduced by 3.5% with the SDD regimen and by 2.9% with the SOD regimen. The difference between the two antibiotic regimens wasn't significant.
Noting that the number of antibiotic-resistant bacteria didn't increase in patients who got antibiotics, researchers recommend devising an antibiotic policy for the ICU. "We have seen that using antibiotics clearly results in a reduction in the number of deaths," said lead author Dr. Anne Marie de Smet, "and ICUs should make use of this knowledge." The researchers concede, however, that more research is needed to study the long-term effects of routine antibiotic use on antibiotic resistance.
Source: de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360(1):20-31.