SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT REDUCES GRAM-NEGATIVE PULMONARY COLONIZATION BUT NOT SYSTEMIC ENDOTOXEMIA IN PATIENTS UNDERGOING ELECTIVE LIVER-TRANSPLANTATION

Objective: To examine the effect of selective antibiotic decontamination of the digestive tract in patients undergoing elective orthotopic liver transplantation. Design: Prospective, randomized, concurrent allocation to either selective decontamination or standard antibiotic prophylaxis. Setting: Operating theater and intensive care unit at a tertiary referral, university teaching hospital. Patients: Fifty-nine adult patients were recruited into the study and underwent liver transplantation. Interventions: Thirty-two patients were randomized to standard treatment (control group) and 27 patients were randomized to receive selective decontamination. After early deaths and exclusions, 31 controls and 21 decontamination patients were available for analysis. Measurements and Main Results: Portal and systemic endotoxemia, colonization and infection rates, severity of illness (organ system failures, Acute Physiology and Chronic Health Evaluation II score, Therapeutic Intervention Scoring System score), antibiotic costs, and hospital survival rates were measured. Selective decontamination significantly reduced pulmonary infections and enteric, aerobic, and Gram-negative bacillary colonization without facilitating the emergence of resistant organisms, but selective decontamination had no effect on endotoxemia or the development of organ system failures. The financial costs of the selective decontamination regimen outweighed the advantages gained from an associated reduction in antibiotic usage. Conclusion: The failure of selective decontamination to enhance survival rates in many studies of the regimen in critically ill patients may, in part, be related to the inability of selective decontamination to abolish endotoxemia.