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Selective digestive tract decontamination--will it prevent infection with multidrug-resistant gram-negative pathogens

Marc J M Bonten1

  • 1Department of Infectious Diseases and Inflammation, Eijkman-Winkler Center for Microbiology, The Netherlands. mbonten@umcutrecht.nl

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 9, 2006
PubMed

Insights

Selective decontamination of the digestive tract may reduce mortality in intensive care units (ICUs). However, concerns remain regarding antibiotic resistance and the need for further research to confirm benefits and address potential drawbacks.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Selective decontamination of the digestive tract (SDD) aims to treat and prevent infections in intensive care unit (ICU) patients.
  • While SDD has shown promise in reducing ventilator-associated pneumonia, concerns include lack of mortality reduction, cost-effectiveness, and antibiotic resistance.
  • Recent studies suggest potential mortality benefits, but were conducted in low-resistance settings with unresolved methodological issues.

Purpose of the Study:

  • To evaluate the effectiveness of selective decontamination of the digestive tract in reducing infections and mortality in ICU patients.
  • To address the ongoing debate regarding the benefits and risks of SDD, particularly concerning antibiotic resistance.

Main Methods:

  • Intravenous and topical antibiotic administration in ICU patients.
  • Analysis of data from controlled, randomized studies investigating SDD.
  • Assessment of infection rates, mortality, length of stay, and selection of antibiotic-resistant pathogens.

Main Results:

  • Some studies demonstrate a reduction in ventilator-associated pneumonia incidence.
  • Recent trials report significant reductions in ICU mortality rates when SDD is combined with strategies to reduce antibiotic resistance.
  • Concerns persist regarding the generalizability of findings to high-resistance settings and potential selection of multidrug-resistant organisms.

Conclusions:

  • SDD may offer survival benefits in ICUs, but requires confirmation in diverse settings.
  • Balancing the potential reduction in mortality against the risk of increased antibiotic resistance is a critical consideration.
  • Further research is needed to resolve methodological issues and establish the optimal role of SDD in critical care.

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