[Selective digestive decontamination in patients under reanimation]

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Context:

• Intensive care unit (ICU) patients face high risks of nosocomial infections due to invasive procedures and compromised health.
• Conventional infection control methods have limitations in preventing colonization by endogenous pathogens.
• Nosocomial pneumonia is a significant cause of mortality in ICUs, often arising from oropharyngeal and gastric secretions.

Purpose:

• To evaluate the efficacy of selective decontamination of the digestive tract (SDD) in preventing bacterial and fungal colonization in ICU patients.
• To assess the impact of SDD on the incidence of nosocomial infections, including pneumonia and other extrapulmonary infections.
• To investigate the effects of SDD on pathogen resistance and patient mortality.

Summary:

• Selective decontamination of the digestive tract (SDD) involves administering nonabsorbable antimicrobial agents to the oropharynx and gastrointestinal tract.
• SDD significantly decreases colonization rates of Gram-negative bacilli and yeasts in the oropharynx and GI tract, but tracheal decontamination is less certain.
• While SDD reduces overall nosocomial infections, particularly Gram-negative pneumonia, it has been associated with the emergence of Gram-positive organisms and resistance in Gram-negative bacteria.

Impact:

• SDD demonstrates significant benefits in reducing nosocomial infections in specific patient populations, including trauma, burn, and liver transplant recipients.
• Despite a reduction in infection rates, most studies utilizing SDD have not shown a significant decrease in overall patient mortality.
• Recolonization by pathogens occurs rapidly after discontinuation of the SDD regimen, highlighting the need for sustained strategies.