The BMJ Today: Selective decontamination revisited and healthcare reform in Massachusetts

georg_rogglaRichard Price and co-workers published a network meta analysis evaluating the effect on mortality of selective digestive decontamination (SDD), selective oropharyngeal decontamination (SOD), and topical oropharyngeal chlorhexidine in patients in general intensive care units. They found that both SDD and SOD confer a mortality benefit when compared with chlorhexidine.

The guidelines for management of severe sepsis and septic shock from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine recommend the use of SDD, SOD, and chlorhexidine as measures for infection prevention. This network meta analysis only partly supports these guidelines because it only confirms the beneficial effect of SDD and SOD, but reports that chlorhexidine is possibly associated with increased mortality.

SDD and SOD are old therapeutic principles and were introduced into intensive care in the 1980s. The effectiveness of these measures is now well established. SDD and SOD have, however, not been widely accepted and adopted by intensivists, probably because there is still uncertainty regarding the theoretical possibility of causing antimicrobial resistance. The question of whether SDD and SOD should be used in critically ill patients is answered convincingly regarding mortality, but not regarding antimicrobial resistance by this paper.

Another research paper focuses on the effects of healthcare reform in Massachusetts. Karen E Lasser and colleagues report that extending health insurance coverage alone seems insufficient to improving readmission rates to hospitals.

Georg Röggla is an associate editor, BMJ.