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Selective decontamination of the digestive tract and its value for patients in intensive care units
1Department of Microbiology, University Hospital St Rafaël, Leuven, Belgium.
Abstract:
Selective digestive decontamination (SDD) is a method that aims to eradicate the oropharyngeal and gastrointestinal carriage of potentially pathogenic micro-organisms (PPMO) by means of the application of high oropharyngeal and faecal antimicrobial concentrations. The SDD technique has proven its effectiveness in patients with profound granulocytopenia and has become commonplace in most European haematological services. A large number of trials most often uncontrolled or relying on historical controls have evaluated the use of SDD in intensive care patients. This article gives a summary of the effects of SDD on: colonisation of the different mucosae, infection, hospitalisation-time, mortality, cost-benefit aspects and the selection of resistant micro-organisms.
Insights
Selective digestive decontamination (SDD) reduces harmful bacteria in intensive care patients. This review summarizes SDD
Area of Science:
- Medical Microbiology
- Intensive Care Medicine
- Infectious Diseases
Background:
- Selective digestive decontamination (SDD) targets the eradication of potentially pathogenic microorganisms (PPMO) in the oropharyngeal and gastrointestinal tracts.
- SDD involves administering high antimicrobial concentrations orally and rectally.
- The technique is established in European hematology services for patients with severe neutropenia.
Purpose of the Study:
- To review the impact of Selective Digestive Decontamination (SDD) in intensive care unit (ICU) patients.
- To evaluate SDD's effects on microbial colonization, infection rates, and patient outcomes.
- To assess cost-benefit analyses and the emergence of antimicrobial resistance associated with SDD.
Main Methods:
- Review of existing trials evaluating SDD in intensive care settings.
- Analysis of studies, often uncontrolled or using historical controls.
- Summary of data on mucosal colonization, infection incidence, and mortality.
Main Results:
- SDD has demonstrated effectiveness in reducing colonization and infection in specific patient groups.
- Impact on hospitalization duration and overall mortality requires further investigation across diverse ICU populations.
- Concerns exist regarding the selection and spread of resistant microorganisms.
Conclusions:
- SDD is a valuable strategy for managing microbial carriage in high-risk patients, particularly in hematology.
- Further rigorous trials are needed to confirm benefits and address resistance concerns in broader intensive care populations.
- Careful consideration of cost-effectiveness and antimicrobial stewardship is essential for SDD implementation.