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Role of selective decontamination in surgery
G W Tetteroo1, J H Wagenvoort, H A Bruining
1Department of Surgery, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
Abstract:
Aspects of selective decontamination as an antibiotic prophylaxis in general surgery are discussed with respect to the respiratory tract and wound infection. The high rate of nosocomial infection encountered in surgical patients, who experience up to 71 per cent of all such infection, is considered. The infection rate increases to 70-80 per cent after 1 week in the surgical intensive care unit, while the infection-related mortality rate rises to up to 60 per cent. The endogenous origin of nosocomial infection suggests the importance of maintaining colonization resistance to prevent colonization with Gram-negative micro-organisms, especially using selective decontamination which eliminates potentially pathogenic micro-organisms while leaving colonization resistance intact. Selective decontamination has proved effective in decreasing infection rates by 50-80 per cent, and is especially successful in respiratory tract infection. Possible adverse effects and future indications for selective decontamination are discussed.
Insights
Selective decontamination effectively reduces nosocomial infections in general surgery patients by 50-80%. This antibiotic prophylaxis strategy targets respiratory tract and wound infections, preserving essential gut bacteria.
Area of Science:
- Medical Microbiology
- Surgical Infectious Diseases
- Antimicrobial Stewardship
Background:
- Nosocomial infections are prevalent in surgical patients, accounting for up to 71% of all such infections.
- In surgical intensive care units, infection rates can reach 70-80% within a week, with up to 60% mortality.
- Endogenous sources of infection highlight the need to maintain colonization resistance.
Purpose of the Study:
- To discuss selective decontamination as an antibiotic prophylaxis strategy in general surgery.
- To evaluate its impact on respiratory tract and wound infections.
- To explore its role in preventing nosocomial infections by maintaining colonization resistance.
Main Methods:
- Review of selective decontamination protocols in general surgery.
- Analysis of infection rates and mortality in surgical patients.
- Assessment of the impact on Gram-negative micro-organism colonization.
Main Results:
- Selective decontamination reduced infection rates by 50-80%.
- The strategy was particularly successful in preventing respiratory tract infections.
- It aims to eliminate pathogens while preserving endogenous microflora.
Conclusions:
- Selective decontamination is an effective antibiotic prophylaxis for reducing surgical site and respiratory infections.
- It offers a method to combat nosocomial infections by targeting pathogen colonization.
- Further research into adverse effects and expanded indications is warranted.