Control of the intestinal flora can reduce mortality in critically ill patients

New research suggests that preventing severe lung infections in mechanically ventilated intensive care patients with topical antibiotics to the upper gastrointestinal tract significantly improves clinical survival
.

The findings will be presented at the "Hot Topics" meeting of the annual congress of the European Association of Critical Care Medicine in Paris and simultaneously in
the Journal of the American Medical Association (JAMA).

Professor John Myburgh AO, lead author of the study and director of the Department of Critical Care at The George Institute for Global Health, said ventilator-associated pneumonia was the leading cause of
death and disability in critically ill patients receiving mechanical ventilation in intensive care units.

"While the concept of 'selective decontamination' (SDD) of the digestive tract has been around for decades, this is the first large-scale randomized clinical trial using a high-quality commercial formulation
specifically designed to prevent ventilator-associated pneumonia in these patients," he said.
Across nearly 3,000 patients treated with SDD, we found a reduction in mortality of about 2 percent, equivalent to averting one death
per 50 patients treated.
”

SDD is an infection control measure that applies unabsorbed antibiotics and antifungal drugs to the mouth and stomach in combination with a short course of intravenous antibiotics
.

This inhibits the development of ventilator-associated pneumonia caused by an overgrowth of harmful bacteria and fungi, which normally live in the upper part of the intestine but enter and infect the lungs
once the patient is on a ventilator.

While SDD may reduce infections and prevent deaths, it has not been widely adopted
due to weak evidence and widespread concerns about the potential risk of possible antibiotic resistance.

To address this uncertainty, the GI selective decontamination trial in the intensive care unit (SuDDICU) aimed to determine whether adding SDD to routine care for ICU patients reduced all-cause in-hospital mortality
more than usual care alone.

The SuDDICU trial recruited 5982 mechanically ventilated adults
from 19 ICUs in Australia between April 2018 and May 2021.
Each ICU offers SDD and usual care or usual care alone for 12 months, then switches to other options
during the second 12 months.

The study found that while standard-of-care SDD did not result in a statistically significant reduction in in-hospital mortality compared with standard care alone (27.
0 versus 29.
1 percent, respectively), the range of values included clinically important benefits
.

Professor Myburgh said: "In addition, we found that SDD was associated with a significant reduction in new hospital-acquired infections, and there were no adverse events
related to SDD itself.
"

The George Institute researchers combined the results of other major randomized clinical trials of SDD conducted over the past 20 years for a systematic review and meta-analysis, also published in the Journal of the American Medical Association and presented at the conference by senior author Associate Professor Anthony Delaney
.

Effect of selective decontamination of the digestive tract on hospital mortality in critically ill patients receiving mechanical ventilation