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[Selective intestinal decontamination--yes or no?]
1Klinikhygiene, Universitätsklinikum Freiburg.
Abstract:
Various studies have shown that as a result of selective decontamination of the digestive tract, the incidence of pneumonia in artificial ventilation caused by gram-negative bacteria is reduced; however, a few studies have pointed out that, at the same time, the rate of pneumonia caused by gram-positive bacteria is increased. Most investigators agree that mortality cannot be reduced. A few studies have demonstrated that simultaneous administration of cefotaxime is not necessary. Various recent reports indicate that under certain conditions selective decontamination of the digestive tract undoubtedly leads to the development of resistance to gram-negative bacteria and in particular, to oxacillin-resistant staphylococci, S. epidermidis, and enterococci. Multicenter, randomized, and prospective double-blind studies will have to investigate and establish definitively which antibiotics have to be applied in which patients in order to reduce the rate of pneumonia as well as mortality. In addition, these studies will have to determine the microbiological and hospital hygiene measures necessary to avoid the risk of resistance or colonization developing by certain agents. As long as this is not the case, broad, non-selective use of SDD is not justified, especially in intensive care units.
Insights
Selective digestive decontamination (SDD) reduces gram-negative pneumonia but may increase gram-positive infections. Mortality benefits are unclear, and SDD can drive antibiotic resistance, questioning its broad use.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Context:
- Selective digestive decontamination (SDD) is used in mechanically ventilated patients to prevent pneumonia.
- While SDD reduces gram-negative bacterial pneumonia, concerns exist regarding increased gram-positive infections.
Purpose:
- To evaluate the efficacy and safety of selective digestive decontamination (SDD) in preventing pneumonia in artificial ventilation.
- To assess the impact of SDD on bacterial resistance and patient mortality.
Summary:
- SDD reduces gram-negative pneumonia incidence but may increase gram-positive pneumonia.
- Current evidence does not consistently show a reduction in mortality with SDD.
- SDD use is linked to the development of resistance in gram-negative bacteria and specific gram-positive organisms like oxacillin-resistant staphylococci.
Impact:
- The emergence of antibiotic resistance necessitates further research into optimal antibiotic strategies and hygiene measures.
- Broad, non-selective application of SDD, particularly in intensive care units, is not currently justified.
- Future multicenter, randomized, prospective double-blind studies are required to define appropriate antibiotic use and preventive strategies against resistance and colonization.