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[Selective digestive decontamination: the light as changed from red to green]
J Textoris1, M Leone, W A Boyle
1Département d'anesthésie-réanimation, centre hospitalier universitaire Nord, 13015 Marseille, France. julien.textoris@free.fr
Annales Francaises D'Anesthesie Et De Reanimation
|April 14, 2005
Summary
Selective digestive decontamination (SDD) shows promise in preventing pneumonia in intensive care units but may increase multiresistant bacteria. Its use should be targeted to specific patient groups with low resistance rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Context:
- Nosocomial infections, particularly pneumonia, are a significant concern in intensive care units (ICUs).
- Selective digestive decontamination (SDD) involves administering antibiotics to reduce bacterial colonization in the digestive tract.
- The emergence of multiresistant bacteria poses a growing threat to patient care.
Purpose:
- To evaluate the effectiveness of SDD in preventing nosocomial infections, especially pneumonia.
- To assess the impact of SDD on the development of multiresistant bacteria.
- To identify patient populations and settings where SDD may be most beneficial.
Summary:
- A review of ten randomized clinical trials in mechanically ventilated adult ICU patients was conducted.
- Five studies indicated SDD reduced pneumonia incidence, but only one showed decreased mortality.
- Concerns exist regarding SDD's role in fostering multiresistant bacteria, influenced by environmental factors and infection control practices.
Impact:
- SDD may be effective for specific patient groups, such as multiple trauma patients in ICUs with low rates of multiresistant bacteria.
- Careful consideration of local resistance patterns and infection control is crucial when implementing SDD.
- Further research may be needed to optimize SDD protocols and mitigate resistance development.