Skip to main content
SpringerLink
Log in

Selective Decontamination of the Digestive Tract: the Role of the Pharmacist

  • Chapter
Infection Control in the Intensive Care Unit

Part of the book series: Topics in Anaesthesia and Critical Care ((TIACC))

Conclusion

Although the application of the SDD concept to intensive care medicine has been proven to reduce ICU-related morbidity and mortality and in spite of a recent publication validating SDD as an evidence-based medicine maneuver [51], the SDD approach is still not widely used on ICUs. Reasons for this may include:

1. SDD is contrary to the traditional concept that prophylaxis creates resistance.

2. A primacy of opinion over evidence.

3. Opinion leaders control the medical media.

4. SDD formulations are not marketed by the pharmaceutical industry.

5. There is little physician-pharmaceutical industry interaction to stimulate industry interest in manufacturing SDD products.

In the current climate, with a lack of commercial products, the necessary extemporaneous production of SDD formulations must be undertaken by a pharmacy department that is able to commit to the additional workload that this entails. This means that at present the formulation and supply role of the hospital pharmacist is vital in order to facilitate the application of the SDD concept to clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Silvestri L, van Saene HKF, Gullo A (1997) Selective decontamination of the digestive tract in critically ill patients: a pathogenesis-based infection control method. Care Crit Ill 13:227–232

    Google Scholar 

  2. van Saene HKF, Damjanovic V, Murray AE, de la Cal MA (1996) How to classify infections in intensive care units—the carrier state, a criterion whose time has come? J Hosp Infect 33:1–12

    Article  PubMed  Google Scholar 

  3. Morar P, Makura Z, Jones A, Baines P, Selby A, Hughes J, van Saene HKF (2000) Topical antibiotics on tracheostoma prevents exogenous colonization and infection of lower airways in children. Chest 117:513–518

    Article  PubMed  CAS  Google Scholar 

  4. Gray J, Gossain S, Morris K (2001) Three-year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 20:416–421

    Article  PubMed  CAS  Google Scholar 

  5. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in pediatric intensive care units in the United States. Pediatrics 103:1–7

    Article  Google Scholar 

  6. Singh-Naz N, Sprague BM, Patel KM, Pollack MM (2000) Risk assessment and standardised nosocomial infection rate in critically children. Crit Care Med 28:2069–2075

    Article  PubMed  CAS  Google Scholar 

  7. Patel JC, Mollitt DL, Pieper P, Tepas JJ (2000) Nosocomial pneumonia in the pediatric trauma patient: a single center’s experience. Crit Care Med 28:3530–3533

    Article  PubMed  CAS  Google Scholar 

  8. Albers MJIJ, Mouton JW, Tibboel D (2001) Colonization and infection by Serratia species in a paediatric surgical intensive care unit. J Hosp Infect 48:7–12

    Article  PubMed  CAS  Google Scholar 

  9. Ruza F, Alvarado F, Herruzo R, Delagado MA, Garcia S, Dorao P, Goded F (1998) Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. Eur J Epidemiol 14:719–727

    Article  PubMed  CAS  Google Scholar 

  10. Zobel G, Kuttnig M, Graubbauer HM, Semmelrock HJ, Thiel W (1991) Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract. Crit Care Med 19: 1242–1246

    PubMed  CAS  Google Scholar 

  11. Smith SD, Jackson RJ, Hannakan CJ, Wadowsky RM, Tzakis AG, Rowe MI (1993) Selective decontamination in pediatric liver transplants. Transplantation 55:1306–1309

    PubMed  CAS  Google Scholar 

  12. Barret JP, Jeschke MG, Herndon DN (2001) Selective decontamination of the digestive tract in severely burned pediatric patients. Burns 27:439–445

    Article  PubMed  CAS  Google Scholar 

  13. Herruzo-Cabrera R, Garcia Gonzalez JI, Garcia-Magan P, Del Rey-Calero JD (1994) Nosocomial infection in a neonatal intensive care unit and its prevention with selective intestinal decolonisation. Eur J Epidemiol 10: 573–580

    Article  PubMed  CAS  Google Scholar 

  14. van Saene HKF, Stoutenbeek CP, Miranda DR, Zandstra DF, Homan van der Heide JN (1984) A new strategy for infection control in an intensive care unit: a prospective two-year study in cardiac surgery babies. In: Kinderchirurgie Kongressberichte. Surgery in infancy and childhood. Hippokrates Verlag Stuttgart 1985, pp. 168–175

    Google Scholar 

  15. Liberati A, D’Amico R, Pifferi S et al (2004) Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care [Cochrane Review]. In: The Cochrane Library, Issue 1, Chichester, UK, John Wiley & Sons Ltd

    Google Scholar 

  16. Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients. A systematic review of the evidence. Arch Surg 134:170–176

    Article  PubMed  CAS  Google Scholar 

  17. Sarginson RE, Taylor N, Reilly N et al (2004) Infection in prolonged pediatric critical illness: A prospective four-year study based on knowledge of the carrier state. Crit Care Med 32:839–847.

    Article  PubMed  CAS  Google Scholar 

  18. Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10: 185–192

    Article  PubMed  CAS  Google Scholar 

  19. Baxby D, van Saene HKF, Stoutenbeek CP, Zandstra DF (1996) Selective decontamination of the digestive tract: 13 years on,what it is, and what it is not. Intensive Care Med 22:699–706

    PubMed  CAS  Google Scholar 

  20. Silvestri L, Mannucci F, van Saene HKF (2000) Selective decontamination of the digestive tract: a life-saver. J Hosp Infect 45:185–190

    Article  PubMed  CAS  Google Scholar 

  21. Sganga G, Gangeri G, Castagneto M (1998) The gut: a central organ in the development of multiple organ system failure. In: van Saene HKF, Silvestri L, de la Cal MA (eds) Infection control in the intensive care unit. Springer-Verlag, Milan, pp 257–268

    Google Scholar 

  22. Pierro A, van Saene HKF, Donnell SC, Hughes J, Ewan C, Nunn AJ, Lloyd DA (1996) Microbial translocation in neonates and infants receiving long-term parenteral nutrition. Arch Surg 131:176–179

    PubMed  CAS  Google Scholar 

  23. Pierro A, van Saene HKF, Jones MO, Brown D, Nunn AJ, Lloyd DA (1998) Clinical impact of abnormal gut flora in infants receiving parenteral nutrition. Ann Surg 227:1–7

    Article  Google Scholar 

  24. van Saene HKF, Stoutenbeek CP, Hart CA (1991) Selective decontamination of the digestive tract (SDD) in intensive care patients: a critical evaluation of the clinical, bacteriological and epidemiological benefits. J Hosp Infect 18:261–277

    Article  PubMed  Google Scholar 

  25. van Saene HKF, Martin MV (1990) Do microorganisms play a role in irradiation mucositis? Eur J Clin Microbiol Infect Dis 9:861–863

    Article  PubMed  Google Scholar 

  26. Stoutenbeek CP (1988) Topical antibiotic regimen. In: van Saene HKF, Stoutenbeek CP, Lawin P, Ledingham IM (eds) Infection control by selective decontamination. Springer-Verlag, Berlin Heidelberg New York, pp 95–101

    Google Scholar 

  27. Markowsky SJ, Sinnott JT, Houston SH (1993) Selective decontamination of the digestive tract in intensive care patients. Infect Dis Newslett 12:49–56

    Article  Google Scholar 

  28. Rogers CJ, van Saene HK, Suter PM, Horner R, L’E Orme M (1994) Infection control in critically ill patients: effects of selective decontamination of the digestive tract. Am J Hosp Pharm 51:631–648

    PubMed  CAS  Google Scholar 

  29. van Saene HKF, Stoutenbeek CP, Faber-Nijholt R, van Saene JJM (1992) Selective decontamination of the digestive tract contributes to the control of disseminated intravascular coagulation in severe liver impairment. J Pediatr Gastroenterol Nutr 14:436–442

    Article  PubMed  Google Scholar 

  30. Gomez EC, Markowsky SJ, Rotschafer JC (1992) Selective decontamination of the digestive tract in intensive care patients: review and commentary. Ann Pharmacother 26:963–976

    PubMed  CAS  Google Scholar 

  31. Ramsay G (1988) Endotoxaemia in multiple organ failure: a secondary role for SDD? In: van Saene HKF, Stoutenbeek CP, Lawin P, Ledingham IM (eds) Infection control by selective decontamination. Springer-Verlag, Berlin Heidelberg New York, pp 135–142

    Google Scholar 

  32. Hofstra W, De Vries-Hospers HG, Van der Waaij D (1982) Concentrations of amphotericin B in faeces and blood of healthy volunteers after the oral administration of various doses. Infection 10:223–227

    Article  PubMed  CAS  Google Scholar 

  33. Alder Hey, Royal Liverpool Children’s NHS Trust. Anti-infective Guidelines, (1999)

    Google Scholar 

  34. Feron B, Adair CG, Gorman SP, McClurg B (1993) Interaction of sucralfate with antibiotics used for selective decontamination of the gastrointestinal tract. Am J Hosp Pharm 50:2550–2553

    PubMed  CAS  Google Scholar 

  35. Boom S, Ramsay G (1991) Selective decontamination of the digestive tract. Theoretical and practical recommendations. Drugs 42:541–550

    PubMed  CAS  Google Scholar 

  36. Crome D (1989) Pharmaceutical technology in selective decontamination. In: van Saene HKF, Stoutenbeek CP, Lawin P, Mc A Ledingham I (eds) Infection control by selective decontamination. Springer Verlag, Berlin Heidelberg New York, pp 109–112

    Google Scholar 

  37. Data on file. Royal Liverpool Children’s Hospital NHS Trust, Alder Hey, Liverpool, UK

    Google Scholar 

  38. van Saene HKF, Nunn AJ, Stoutenbeek CP (1995) Selective decontamination of the digestive tract in intensive care patients. Br J Hosp Med 54:558–561

    PubMed  Google Scholar 

  39. Data on file. Western Infirmary, Glasgow, UK

    Google Scholar 

  40. Symonds RP, McIlroy P, Khorrami J, Paul J, Pyper E, Alcock SR, McCallum I, Speekenbrink ABJ, McMurray A, Lindemann E, Thomas M (1996) The reduction of radiation mucositis by selective decontamination antibiotic pastilles: a placebo-controlled double-blind trial. Br J Cancer 74:312–317

    PubMed  CAS  Google Scholar 

  41. Spijkervet FKL, van Saene HKF, van Saene JJM, Panders AK, Vermey A, Mehta DM, Fidler V (1991) Effect of selective elimination of the oral flora on mucositis in irradiated head and neck cancer patients. J Surg Oncol 46:167–173

    PubMed  CAS  Google Scholar 

  42. Data on file. Organon, Oss, The Netherlands

    Google Scholar 

  43. Occhipinti DJ, Itokazu G, Danziger LH (1992) Selective decontamination of the digestive tract as an infection control measure in intensive care unit patients. Pharmacotherapy 12:50S–63S

    PubMed  CAS  Google Scholar 

  44. van Saene JJM (1990) Colonic delivery of polymyxin E and four quinolones for flora suppression. PhD Thesis, University of Groningen, PAL, Amsterdam

    Google Scholar 

  45. Poth EJ (1957) Critical analysis of intestinal antisepsis. JAMA 1163:1317–1322

    Google Scholar 

  46. Jew RK, Owen D, Kaufman D, Balmer D (1997) Osmolality of commonly used medications and formulas in the neonatal intensive care unit. Nutr Clin Pract 12:158–163

    Article  Google Scholar 

  47. Bonten MJ, Kullberg BJ, Van Dalen R, Girbes AR, Hoepelman IM, Hustinx W, Meer JW van der, Speelman P, Stobberingh EE, Verbrugh HA, Verhoef J, Zwaveling JH (2000) Selective digestive decontamination in patients in intensive care. The Dutch Working Group on Antibiotic Policy. J Antimicrob Chemother 46:351–362

    Article  PubMed  CAS  Google Scholar 

  48. Kollef MH (2000) Opinion: the clinical use of selective digestive decontamination. Crit Care 4: 327–332

    Article  PubMed  CAS  Google Scholar 

  49. Sanchez Garcia M, Cambronero Galache JA, Lopez Diaz J, Cerda Cerda E, Blasco JR et al (1998) Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. Am J Respir Crit Care Med 158:908–916

    PubMed  CAS  Google Scholar 

  50. Collard HR, Saint S (2001) Prevention of ventilator-associated pneumonia. Making health care safer: a critical analysis of patient safety practices. AHRQ Publication 01-E058. www.ahrq.gov

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacy, Alder Hey Children’s Hospital, Liverpool, UK

    N.J. Reilly & A.J. Nunn

  2. Department of Pharmacy, Western Infirmary, Glasgow, UK

    K. Pollock

Authors
  1. N.J. Reilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A.J. Nunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Pollock
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medical Microbiology, University of Liverpool Alder Hey Children’s Hospital, NHS Trust, Liverpool, UK

    H. K. F. van Saene M.D.

  2. Department of Critical Care Medicine, University Hospital of Getafe, Madrid, Spain

    M. A. De La Cal M.D.

  3. Emergency Department and Unit of Anesthesia and Intensive Care, Presidio Ospedaliero of Gorizia, Gorizia, Italy

    L. Silvestri M.D.

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer-Verlag Italia

About this chapter

Cite this chapter

Reilly, N., Nunn, A., Pollock, K. (2005). Selective Decontamination of the Digestive Tract: the Role of the Pharmacist. In: van Saene, H.K.F., De La Cal, M.A., Silvestri, L. (eds) Infection Control in the Intensive Care Unit. Topics in Anaesthesia and Critical Care. Springer, Milano . https://doi.org/10.1007/88-470-0361-X_27

Download citation

  • DOI: https://doi.org/10.1007/88-470-0361-X_27

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0185-5

  • Online ISBN: 978-88-470-0361-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation