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Selective decontamination of the digestive tract as an infection-control measure in intensive care unit patients
D J Occhipinti1, G Itokazu, L H Danziger
1Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612.
Abstract:
Infection is responsible for a large percentage of morbidity and mortality in intensive care unit (ICU) patients. Conventional infection-control measures are directed at decreasing infection by exogenous sources and have had variable success in significantly reducing nosocomial infection rates. Selective gastrointestinal decontamination with topical nonabsorbable antibiotics attempts to reduce infection by eliminating intestinal mucosal colonization by pathogenic microorganisms. These antibiotics are selectively bactericidal against gram-negative organisms and yeasts, thereby leaving the normal flora (mainly anaerobes) unharmed. In the majority of clinical trials, selective decontamination effectively reduced colonization and infection among ICU patients, with the most significant reductions observed in gram-negative respiratory infections. Resistance to the antimicrobials was not documented in the majority of trials; however, follow-up periods were minimal and may not have been adequate to detect selection of resistant strains. Reductions in infection do not alter mortality; however, patients without significant underlying disease appear to be the subgroup that will most likely benefit.
Insights
Selective gastrointestinal decontamination using topical antibiotics effectively reduces infections in intensive care unit (ICU) patients, particularly gram-negative respiratory infections. This method shows promise for reducing nosocomial infections without increasing antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Infections contribute significantly to morbidity and mortality in intensive care unit (ICU) patients.
- Conventional infection control measures have limited success in reducing nosocomial infections.
- Selective gastrointestinal decontamination (SGID) aims to reduce infection by targeting intestinal colonization.
Purpose of the Study:
- To evaluate the efficacy of selective gastrointestinal decontamination in reducing infections among ICU patients.
- To assess the impact of SGID on colonization by pathogenic microorganisms.
- To investigate the development of antimicrobial resistance associated with SGID.
Main Methods:
- Administration of topical nonabsorbable antibiotics to selectively target gram-negative organisms and yeasts in the gastrointestinal tract.
- Monitoring of patient colonization and infection rates.
- Assessment of antimicrobial resistance patterns.
Main Results:
- SGID effectively reduced intestinal colonization and infection rates in the majority of clinical trials.
- Significant reductions in gram-negative respiratory infections were observed.
- Antimicrobial resistance was not widely documented, though follow-up periods were limited.
Conclusions:
- Selective gastrointestinal decontamination is an effective strategy for reducing infections in ICU patients.
- The primary benefit is observed in reducing gram-negative respiratory infections.
- Patients without significant underlying disease appear to benefit most; SGID does not alter overall mortality.