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Selective decontamination of the digestive tract
Wolfgang A Krueger1, Klaus E Unertl
1Department of Anesthesiology and Intensive Care Medicine, Tuebingen University Hospital, Tuebingen, Germany. wolfgang.krueger@uni-tuebingen.de
Current Opinion in Critical Care
|October 19, 2002
Summary
Selective digestive decontamination (SDD) reduces pneumonia incidence but its effect on mortality is debated. SDD involves topical antibiotics to prevent infections, but careful patient and ICU selection is crucial to minimize resistance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) commonly arises from the patient's oropharyngeal microflora.
- Selective digestive decontamination (SDD) uses topical antibiotics in the oropharynx and stomach to prevent VAP and other infections.
Purpose of the Study:
- To evaluate the effectiveness and controversies surrounding selective digestive decontamination in preventing infections and reducing mortality.
- To explore the role of SDD in conditions like acute necrotizing pancreatitis and liver transplantation.
Main Methods:
- Review of numerous clinical trials examining the use of topical antibiotics for infection prevention.
- Meta-analyses to assess the impact of SDD on mortality, particularly in surgical ICU patients receiving combined topical and systemic antibiotics.
Main Results:
- A reduction in pneumonia incidence is generally accepted, though the magnitude of this reduction is debated.
- Most individual trials did not show reduced mortality, but meta-analyses suggest a potential benefit, especially in surgical ICU settings.
- Concerns exist regarding increased antibiotic resistance and a shift towards Gram-positive pathogens.
Conclusions:
- SDD requires careful patient selection based on underlying diseases and illness severity, alongside ICU selection considering endemic resistance patterns.
- Optimizing SDD involves not only selective bacterial suppression but also judicious application to minimize risks like increased resistance.