The incidence of
respiratory tract infections was determined in 59
multiple trauma patients requiring prolonged
intensive care (greater than 5 days) and receiving no
antibiotic prophylaxis. Early
pneumonia (less than 48 hr) with S. aureus, S. pneumoniae, and/or H. influenzae was found in 44% of patients. Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by
pneumonia occurred in 12 patients (20%). The overall incidence of
respiratory tract infections was 59%. In a prospective open trial three prophylactic
antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable
antibiotics (
polymyxin E 400 mg,
tobramycin 320 mg,
amphotericin B 2,000 mg/day). No difference in
infection rate was found. Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an
ointment containing 2% of the same
antibiotics. Secondary colonization and
infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p less than 0.001). The incidence of early (Gram-positive)
infections, however, was unchanged. Another group of 63 patients was treated with systemic
antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination. The incidence of early
pneumonia was significantly reduced (p less than 0.001). Five patients (8%) developed an
infection.
Superinfections were not observed.