Researchers studying nearly 6,000 patients in intensive care units (ICUs) in 13 hospitals throughout the Netherlands, found that giving antibiotics as a preventive measure to ICU patients increased their chances of survival.
The study was the work of first author Dr. Anne Marie de Smet, an anesthesiologist-intensivist at the Division of Perioperative and Emergency Care of the University Medical Center (UMC) Utrecht in The Netherlands, and colleagues, and is published in the 1 January 2009 issue of the New England Journal of Medicine, NEJM.
Two types of antibiotic treatment are often used to prevent infection in some ICU patients: selective oropharyngeal decontamination (SOD, administered via the mouth) and selective digestive tract decontamination (SDD, straight into the digestive tract). But so far studies examining the effectiveness of these methods have shown conflicting results, wrote the authors in their background information.
For the study, de Smet and colleagues compared standard ICU care with the effect of these two types of antibiotic treatment by putting nearly 5,939 patients into one of these three treatment groups. The patients, who were hospitalized in ICUs between 2004 and 2006, were selected for the study because they were either expected to be be in ICU for at three days and/or to be intubated (on a ventilator) for at least two days.
In the SOD group, 1,904 patients received an oral antibiotic paste four times a day. In the SDD group, 2,045 patients also received the oral paste four times a day plus they were also given antibiotics via a gastric tube into the intestinal tract and also via intravenous drip. In the control group, 1,990 patients received standard ICU care.
The results showed that:
- After 4 weeks, fewer patients had died in the antibiotic groups than in the control group (26.6 per cent in the SOD, 26.9 per cent in the SDD, and 27.5 per cent in the control group).
- Preventive use of antibiotics in the SDD group reduced deaths by 3.5 per cent, and the SOD group by 2.9 per cent compared to the control group.
- There was no significant difference between the two antibiotic groups in measured outcomes.
- Also, there was no increase in the number of antibiotic-resistant bacteria among patients in the antibiotics groups.
- Although the patients in the control group were in a slightly more serious condition, the researchers took this into account and adjusted the results to rule out this effect.
The authors concluded that:
“In an ICU population in which the mortality rate associated with standard care was 27.5 per cent at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD.”
De Smet said the findings are clearly conclusive and help to settle a long running debate about whether the advantages of using antibiotics to prevent infection outweigh the possibility of developing antibiotic resistance.
“I believe we should revise the antibiotic policy for the ICU,” said De Smet.
“Because the study was conducted in thirteen Dutch hospitals, the conclusions can be implemented throughout the country. We have seen that using antibiotics clearly results in a reduction in the number of deaths, and ICUs should make use of this knowledge,” she added.
However, while these results are promising, the study focused on short term results, and further research is needed to investigate whether resistance to antibiotics would develop in the longer term.
Every year in the Netherlands, more than 18,000 patients spend more than three days in ICUs.
“Decontamination of the Digestive Tract and Oropharynx in ICU Patients.”
de Smet, A.M.G.A., Kluytmans, J.A.J.W., Cooper, B.S., Mascini, E.M., Benus, R.F.J., van der Werf, T.S., van der Hoeven, J.G., Pickkers, P., Bogaers -Hofman, D., van der Meer, N.J.M., Bernards, A.T., Kuijper, E.J., Joore, J.C.A., Leverstein-van Hall, M.A., Bindels, A.J.G.H., Jansz, A.R., Wesselink, R.M.J., de Jongh, B.M., Dennesen, P.J.W., van Asselt, G.J., te Velde, L.F., Frenay, I.H.M.E., Kaasjager, K., Bosch, F.H., van Iterson, M., Thijsen, S.F.T., Kluge, G.H., Pauw, W., de Vries, J.W., Kaan, J.A., Arends, J.P., Aarts, L.P.H.J., Sturm, P.D.J., Harinck, H.I.J., Voss, A., Uijtendaal, E.V., Blok, H.E.M., Thieme Groen, E.S., Pouw, M.E., Kalkman, C.J., Bonten, M.J.M.
New England Journal of Medicine, NEJM January 1, 2009, Vol 360, Number 1, pages 20 – 31.
Sources: Journal abstract, University Medical Center Utrecht.
Written by: Catharine Paddock, PhD