Related Experiment Videos
Selective decontamination in pediatric liver transplants. A randomized prospective study
S D Smith1, R J Jackson, C J Hannakan
1Children's Hospital of Pittsburgh, Pennsylvania.
Insights
Selective digestive tract decontamination (SDD) significantly reduced Gram-negative infections in pediatric liver transplant patients. This approach lowered infection rates without impacting mortality, offering a promising strategy for post-transplant care.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Infectious disease epidemiology
Background:
- Selective digestive tract decontamination (SDD) is hypothesized to reduce infections after orthotopic liver transplantation (OLT).
- Controlled trials evaluating SDD in pediatric OLT patients are lacking.
- Postoperative infections remain a significant concern in pediatric OLT recipients.
Purpose of the Study:
- To investigate the efficacy of short-term postoperative selective digestive tract decontamination (SDD) in reducing infections in pediatric orthotopic liver transplantation (OLT) patients.
- To analyze the impact of SDD on the digestive tract flora of pediatric OLT patients.
- To compare postoperative infection rates and mortality between SDD and control groups in pediatric OLT.
Main Methods:
- Prospective, randomized controlled study involving 36 pediatric OLT patients.
- Patients were randomized to either a control group (parenteral antibiotics) or an SDD group (parenteral antibiotics plus enteral/oropharyngeal polymyxin E, tobramycin, and amphotericin B).
- SDD was administered postoperatively until oral intake was tolerated (mean duration 6 +/- 4 days).
Main Results:
- The SDD group showed a significantly lower incidence of Gram-negative infections (11% vs. 50% in the control group, P < 0.001).
- SDD led to a significant reduction in aerobic Gram-negative flora in stool and pharyngeal samples.
- No significant differences were observed in mortality, indications for operation, preoperative status, age, or length of intensive care unit and hospital stay between the groups.
Conclusions:
- Short-term postoperative selective digestive tract decontamination (SDD) is effective in significantly reducing Gram-negative infections in pediatric OLT patients.
- SDD alters the digestive tract flora by decreasing aerobic Gram-negative organisms.
- The findings support the use of SDD as an adjunctive therapy to prevent Gram-negative infections in this vulnerable pediatric population.
Abstract:
Although it has been suggested that selective decontamination of the digestive tract (SDD) decreases postoperative aerobic Gram-negative and fungal infections in orthotopic liver transplantation (OLT), no controlled trials exist in pediatric patients. This prospective, randomized controlled study of 36 pediatric OLT patients examines the effect of short-term SDD on postoperative infection and digestive tract flora. Patients were randomized into two groups. The control group received perioperative parenteral antibiotics only. The SDD group received in addition polymyxin E, tobramycin, and amphotericin B enterally and by oropharyngeal swab postoperatively until oral intake was tolerated (6 +/- 4 days). Indications for operation, preoperative status, age, and intensive care unit and hospital length of stay were no different in SDD (n = 18) and control (n = 18) groups. A total of 14 Gram-negative infections (intraabdominal abscess 7, septicemia 5, pneumonia 1, urinary tract 1) developed in the 36 patients studied. Mortality was not significantly different in the two groups. However, there were significantly fewer patients with Gram-negative infections in the SDD group: 3/18 patients (11%) vs. 11/18 patients (50%) in the control group, P < 0.001. There was also significant reduction in aerobic Gram-negative flora in the stool and pharynx in patients receiving SDD. Gram-positive and anaerobic organisms were unaffected. We conclude that short-term postoperative SDD significantly reduces Gram-negative infections in pediatric OLT patients.