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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.

Transplantation
|June 1, 1993
PubMed
Summary

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.

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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:

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  • 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.