Selective decontamination of the digestive tract: cumulating evidence, at last?

Seminars in Respiratory and Critical Care Medicine
Marc J M Bonten, Wolfgang A Krueger

Abstract

Selective decontamination of the digestive tract (SDD), an infection-control strategy designed to prevent nosocomial pneumonia in mechanically ventilated patients, has been implemented in numerous studies for more than 2 decades, but its role remains controversial. Sentinel studies in the 1960s and 1970s identified a link between colonization of the upper respiratory tract and subsequent increased risk of developing nosocomial pneumonia in critically ill patients. Studies in the 1980s found that prophylaxis with topical and systemic antibiotics to decontamination of the upper respiratory tract and gastrointestinal tract (particularly depleting gram-negative aerobic bacteria) was associated with lower rates of infections. However, impact on survival was not substantiated. However, several recent studies (including randomized trials and meta-analyses) suggest that SDD may improve survival in selected cohorts of critically ill patients in intensive care units (ICUs). Because liberal use of SDD (or any antimicrobial prophylactic strategy) may lead to escalating antimicrobial resistance, the risk of resistance varies according to local pathogens and resistance patterns. This review describes the development of the SDD concept, discu...Continue Reading

Citations

Aug 10, 2006·Intensive Care Medicine·Alexandra HeiningerWolfgang A Krueger
Aug 21, 2012·Digestive Diseases and Sciences·Kentaro ShimizuHisashi Sugimoto
Dec 22, 2009·Medicina clínica·Marta UlldemolinsJordi Rello
Nov 23, 2006·The Surgical Clinics of North America·Jason R Leong, David T Huang
Oct 28, 2008·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Richard J WallJayant K Deshpande
Feb 9, 2011·Therapeutic Advances in Respiratory Disease·Diego J Maselli, Marcos I Restrepo
Oct 29, 2010·Critical Care Research and Practice·Lenneke E M Haas, Marcus J Schultz
Apr 17, 2009·The Cochrane Database of Systematic Reviews·Matan J CohenKarla Soares-Weiser

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