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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection

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Selective digestive tract decontamination in critically ill patients.

Luciano Silvestri¹, Hendrick K F van Saene, Andy J Petros

¹Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Fatebenefratelli 34, 34170 Gorizia, Italy. lucianosilvestri@yahoo.it

Expert Opinion on Pharmacotherapy

|April 27, 2012

Summary

Selective decontamination of the digestive tract (SDD) reduces infections and mortality in critically ill patients. Evidence confirms SDD efficacy and controls antimicrobial resistance when the full protocol is used.

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Area of Science:

Critical Care Medicine
Infectious Diseases
Clinical Pharmacy

Background:

Selective decontamination of the digestive tract (SDD) aims to prevent infections and reduce mortality in critically ill patients.
Despite RCTs confirming efficacy, SDD faces controversy regarding evidence and antimicrobial resistance concerns.

Purpose of the Study:

To review the philosophy and current evidence on SDD efficacy.
To investigate the impact of SDD on infections, mortality, and antimicrobial resistance.
To analyze SDD effectiveness in specific patient populations.

Main Methods:

Comprehensive literature search of SDD randomized controlled trials (RCTs) using Embase and Medline.
Inclusion of personal archives, meeting abstracts, and cross-referencing of published meta-analyses.
Analysis of up-to-date evidence on SDD's impact on carriage, infections, mortality, and resistance.

Main Results:

SDD significantly reduces lower respiratory tract and bloodstream infections.
SDD decreases the incidence of multiple organ failure and overall mortality.
Evidence suggests SDD controls antimicrobial resistance, especially with a full protocol.

Conclusions:

SDD is effective in reducing key complications and mortality in critically ill patients.
The full SDD protocol, including parenteral and enteral antimicrobials, aids in controlling resistance.
SDD represents a valuable strategy in managing critically ill patients and preventing resistant infections.