Prophylactic Antibiotics Reduce Incidence of ICU Death

The patients were divided into three treatment groups: 1,904 patients in the selective oropharyngeal decontamination (SOD) group received an oral antibiotic paste four times a day; 2,045 patients in the selective digestive tract decontamination (SDD) group received additional antibiotics via a gastric tube and an intravenous (IV) drip; and 1,990 patients in the control group received standard ICU care, without antibiotic supplementation. The patients selected for the study were expected to be in the ICU for at least three days or to be intubated for a minimum of two days.

The study results showed that after 4 weeks, fewer patients had died in the antibiotic groups than in the control group (26.6% in the SOD group, 26.9% in the SDD group, and 27.5% in the control group). Thus, preventive use of antibiotics in the SDD group reduced deaths by 3.5%, and the SOD group by 2.9% compared to the control group. There was no significant difference between the two antibiotic groups in measured outcomes. Additionally, there was no increase in the number of antibiotic-resistant bacteria found among patients in the antibiotics groups. The study was published in the January 1, 2009, issue of The New England Journal of Medicine (NEJM).

"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,” said lead author Anne Marie de Smet, M.D., an anesthesiologist-intensivist at the division of perioperative and emergency care at UMC. "I believe we should revise the antibiotic policy for the ICU.”

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