Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract

McClelland P, P McClelland, Murray AE, A E Murray, P S Williams, Williams PS, van Saene HK, H K van Saene, A A Gilbertson, Gilbertson AA, Mostafa SM, S M Mostafa, J M Bone, Bone JM
Critical care medicine · 1990 · vol. 18(9) , pp. 935–9 · doi:10.1097/00003246-199009000-00006 · PMID:2118443
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Selective decontamination of the digestive tract significantly reduced significant infection rates in patients with severe combined acute renal and respiratory failure requiring mechanical ventilation and renal replacement therapy.

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This study evaluated the efficacy of selective decontamination of the digestive tract (SDD) in fifteen patients with severe combined acute renal and respiratory failure requiring mechanical ventilation and renal replacement therapy. The SDD group demonstrated a significantly lower incidence of definable infections, particularly pulmonary infections caused by Gram-negative bacteria and fungi, compared to twelve historical control patients who did not receive the treatment. Although overall survival rates were comparable between the two groups, the authors noted that mortality appeared related to the presence of infection, suggesting that reducing infectious complications might improve outcomes in critically ill populations. Relevance to endometriosis: The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Fifteen patients with severe combined acute renal and respiratory failure (SCARRF), who required mechanical ventilation and renal replacement therapy for at least 5 days, were treated with a regimen to selectively decontaminate the digestive tract (SDD). In these patients the incidence of significant infection was compared with the infection rate in 12 similar patients with SCARRF who had not received SDD, treated over the preceding 12 months. Both groups were comparable for age, study period, sepsis score, and therapeutic intervention scoring system on admission, although the Acute Physiology and Chronic Health Evaluation score was higher (p less than .05) in the SDD-treated group. Ten (83%) of 12 control patients developed definable infections compared with five (33%) of 15 in the SDD group (p less than .05). Gram-negative bacteria and fungi were responsible for 14 of the 17 infections affecting ten control patients, compared with six of the seven infections in only four SDD patients (p less than .05). The most notable site to benefit was the respiratory tract, with only one patient in the SDD group developing a pulmonary infection compared with five in the control patients (p less than .05). Urine infections may have been reduced from six (50%) of the 12 control patients to two (13%) of the 15 SDD patients, but this difference was not significant. Although survival in the control and SDD group was comparable (42% vs. 40%), mortality overall seemed related to infection. Eleven (73%) of 15 patients with definite infection died, in contrast with five (42%) of 12 who had no infections, although this was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract - PETER McCLELLAND - ALAN E. MURRAY - PETER S. WILLIAMS - HENDRICK K. F. VAN SAENE - ANTHONY A. GILBERTSON - SOBHY M. MOSTAFA - JOHN M. BONE Fifteen patients with severe combined acute renal and respiratory failure (SCARRF), who required mechanical ventilation and renal replacement therapy for at least 5 days, were treated with a regimen to selectively decontaminate the digestive tract (SDD). In these patients the incidence of significant infection was compared with the infection rate in 12 similar patients with SCARRF who had not received SDD, treated over the preceding 12 months. Both groups were comparable for age, study period, sepsis score, and therapeutic intervention scoring system on admission, although the Acute Physiology and Chronic Health Evaluation score was higher (p <.05) in the SDD-treated group. Ten (83%) of 12 control patients developed definable infections compared with five (33%) of 15 in the SDD group (p <.05). Gram-negative bacteria and fungi were responsible for 14 of the 17 infections affecting ten control patients, compared with six of the seven infections in only four SDD patients (p <.05). The most notable site to benefit was the respiratory tract, with only one patient in the SDD group developing a pulmonary infection compared with five in the control patients (p <.05). Urine infections may have been reduced from six (50%) of the 12 control patients to two (13%) of the 15 SDD patients, but this difference was not significant. Although survival in the control and SDD group was comparable (42% vs. 40%), mortality overall seemed related to infection. Eleven (73%) of 15 patients with definite infection died, in contrast with five (42%) of 12 who had no infections, although this was not significant. Nonetheless, reducing infection SDD may help to improve survival in these critically ill patients. (Crit Care Med 1990; 18:935)

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MeSH descriptors

Acute Kidney Injury Digestive System Infection Control Respiratory Insufficiency Acute Kidney Injury Adult Aged Cross Infection Cross Infection Cross Infection Digestive System Female Humans Infections Infections Infections Injections, Intravenous Intensive Care Units Male Middle Aged

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