Abstract
Selective decontamination of the digestive tract (SDD) is an antimicrobial prophylaxis using parenteral and enteral antimicrobials to control severe infections in critically ill patients. SDD is based on the observation that critical illness profoundly affects the body flora, both qualitatively and quantitatively, promoting a shift from normal to abnormal carriage and from low to high carriage (overgrowth) of normal and abnormal flora. The efficacy of SDD in controlling infections and in reducing mortality is based on the ability of the chosen antimicrobials to clear the carriage of potentially pathogenic microorganisms (PPMs) in overgrowth concentration. We present an up-to-date evidence of the impact of SDD on infection and mortality in critically ill, mainly surgical patients.
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References
Silvestri L, de la Cal MA, van Saene HKF (2012) Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth. Intensive Care Med 38:1738–1750
Silvestri L, van Saene HKF, Weir I et al (2009) Survival benefit of the full selective digestive decontamination regimen. J Crit Care 24: 474e7–474e14
de Jonge E, Schultz MJ, Spanjaard L et al (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362:1011–1016
de Smet AM, Kluytmans JA, Cooper BS et al (2009) Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360:20–31
Melsen WG, de Smet AMGA, Kluytmans JAJW et al (2012) Selective decontamination of the oral and digestive tract in surgical versus non-surgical patients in intensive care in a cluster-randomized trial. Br J Surg 99:232–237
Krueger WA, Lenhart F-P, Neeser G et al (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients. Am J Respir Crit Care Med 166:1029–1037
Roos D, Dijksman LM, Oudemans-van Straaten HM et al (2011) Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery. Br J Surg 98:1365–1372
Silvestri L, van Saene HKF (2010) Selective digestive decontamination to prevent pneumonia after esophageal surgery. Ann Thor Cardiovasc Surg 16:220–221
Safdar N, Said A, Lucey MR (2004) The role of selective decontamination for reducing infection in patients undergoing liver transplantation: a systematic review and meta-analysis. Liver Transpl 10:817–827
van der Voort PHJ, van Saene HKF (2008) The role of SDD in liver transplantation: a meta-analysis. In: van der Voort PHJ, van Saene HKF (eds) Selective digestive tract decontamination in intensive care medicine. Springer, Milan, pp 165–172
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
D’Amico R, Pifferi S, Leonetti C et al (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ 316:1275–1285
Landoni G, Rodseth RN, Santini F et al (2012) Randomized evidence for reduction of perioperative mortality. J Cardiothoracic and Vascular Anesthesia 26:764–772
Landoni G, Augoustides JG, Guarracino F et al (2011) Mortality reduction in cardiac anesthesia and intensive care: results of the first International consensus conference. HSR Proc Intensive Care Cardiovasc Anesth 3:9–19
Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637
Silvestri L, van Saene HKF (2006) Selective decontamination of the digestive tract does not increase resistance in critically ill patients: evidence from randomized controlled trials. Crit Care Med 34:2027–2030
Oostdijk EA, de Smet AM, Kesecioglu J et al (2012) Decontamination of cephalosporin-resistant Enterobacteriaceae during selective digestive tract decontamination in intensive care units. J Antimicrob Chemother 67:2250–2253
Taylor N, Cortes-Puch I, Silvestri L et al (2012) Antimicrobial resistance. In: HKF van Saene, L. Silvestri, MA de la Cal, A Gullo (eds.) Infection control in the intensive care unit, 3rd edn. Springer, pp 451–468
Daneman N, Sarwar S, Fowler RA et al (2013) Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis Jan 24 doi:10.1016/S1473-3099(12)70322-5 [Epub ahead of print]
Oudemans-van Straaten HM, Endeman H et al (2011) Presence of tobramycin in blood and urine during selective decontamination of the digestive tract in critically ill patients, a prospective cohort study. Crit Care 15:R240
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Silvestri, L., van Saene, H.K.F. (2014). Selective Decontamination of the Digestive Tract. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-02186-7_14
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DOI: https://doi.org/10.1007/978-3-319-02186-7_14
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