ACCORDING to new research, topical antibiotics applied to the upper digestive tract in mechanically ventilated patients with acute lung infections could result in a significant clinical improvement in survival. Selective decontamination of the digestive tract (SDD) has been a known concept for decades; however, this is the first large randomised clinical trial to utilise a high-quality commercially prepared product that was explicitly designed to prevent ventilator-associated pneumonia in patients who were mechanically ventilated with this condition.
Ventilated-associated pneumonia is a significant cause of death and disability in mechanically ventilated patients who are critically ill in intensive care units. In SDD, non-absorbable antibiotics and antifungal agents are applied to the stomach and mouth, in addition to a short course of antibiotics administered intravenously. The infection measure ensures that the progression of bacteria that causes ventilator-associated pneumonia is inhibited, as the bacteria usually inhabit the upper part of the gut and are ready to infect the lungs when the patients are placed on a ventilator.
In this SuDDICU trial, 5,982 mechanically ventilated patients from 19 intensive care units in Australia were recruited from April 2018 to May 2021. Each intensive care unit delivered either SDD with usual care or usual care alone for 12 months and after this they switched to the alternative option for another period of 12 months. The results showed that SDD with standard care in comparison to standard care alone did not result in a statistically significant reduction in in-hospital mortality (27.0% versus 29.1%, respectively); however, there was a clinically important benefit to the range of benefits. The researchers found that SDD was linked to a remarkable reduction in new infections that could have been acquired in the hospital. Additionally, no adverse events were observed in the administration of SDD alone, and in approximately 3,000 patients treated with SDD there was a 2% reduction in fatalities.
“While the concept of ‘selective decontamination’ of the digestive tract, or ‘SDD’, has been around for decades, this is the first large-scale randomised clinical trial that used a high-quality commercially prepared product specifically designed to prevent ventilator-associated pneumonia in these patients,” said John Myburgh AO, lead author and Director of the Critical Care Division at The George Institute for Global Health, Newtown, Australia.