Skip to main content
SpringerLink
Log in

Antimicrobial Resistance During 20 Years of Clinical SDD Research

  • Chapter
Selective Digestive Tract Decontamination in Intensive Care Medicine: a Practical Guide to Controlling Infection

  • 492 Accesses

Abstract

Selective decontamination of the digestive tract (SDD) is probably the most investigated clinical intervention in critically ill patients treated in intensive care units (ICU). Several meta-analysis studies have been published underlining its efficacy and significance in the reduction of infections in the critically ill patient, especially of ventilator-associated pneumonia (VAP) and bloodstream infections with consequent reductions of mortality by 20% [1]–[3].

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 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

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. 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

    PubMed  CAS  Google Scholar 

  2. 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 

  3. Heyland DK, Cook DJ, Jaeschke R et al (1994) Selective decontamination of the digestive tract. An overview. Chest 105:1221–1229

    CAS  Google Scholar 

  4. Stoutenbeek CP, van Saene HKF, Miranda DR et al (1987) The effect of oropharyngeal decontamination using topical non-absorbable antibiotics on the incidence of nosocomial respiratory infections in multiple trauma patients. J Trauma 27:357–364

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Fridkin SK, Gaynes RP (1999) Antimicrobial resistance in intensive care units. Clin Chest Med 20:303–316

    Article  PubMed  CAS  Google Scholar 

  7. Toltzis Ph, Yamashita T, Vilt L et al (1997) Colonization with antibiotic Gram-negative organisms in a paediatric intensive care unit. Crit Care Med 25:538–544

    Article  PubMed  CAS  Google Scholar 

  8. Garrouste-Orgeas M, Marie O, Rouveau M et al (1996) Secondary carriage with multiresistant Acinetobacter baumannii and Klebsiella pneumoniae in an adult ICU population: relationship with nosocomial infections and mortality. J Hosp Infect 34: 279–289

    Article  PubMed  CAS  Google Scholar 

  9. Johanson WG, Pierce AK, Sanford JP (1969) Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli. N Engl J Med 281:1137–1140

    Article  PubMed  CAS  Google Scholar 

  10. Van Saene HKF, Stoutenbeek CP, Geitz JN et al (1988) Effect of amoxycillin on ‘colonisation resistance’ in human volunteers. Microb Ecol Health Dis 1:169–177

    Article  Google Scholar 

  11. Mobbs KJ, van Saene HKF, Sunderland D et al (1999) Oropharyngeal Gram-negative bacillary carriage. Chest 115:1570–1575

    Article  PubMed  CAS  Google Scholar 

  12. Mackowiak PA, Martin RM, Jones SR et al (1978) Pharyngeal colonisation by Gram-negative bacilli in aspiration prone persons. Arch Intern Med 138:1224–1227

    Article  PubMed  CAS  Google Scholar 

  13. Fuxench-Lopez Z, Ramirez-Ronda CH (1978) Pharyngeal flora in ambulatory alcoholic patients. Arch Intern Med 138:1815–1816

    Article  PubMed  CAS  Google Scholar 

  14. Mobbs KJ, van Saene HKF, Sunderland D et al (1999) Oropharyngeal Gram-negative bacillary carriage in chronic obstructive pulmonary disease: relation to severity of disease. Respir Med 93:540–545

    Article  PubMed  CAS  Google Scholar 

  15. Morris JG, Shay DK, Hebden JN et al (1995) Enterococci resistant to multiple antimicrobial agents, including vancomycin. Ann Intern Med 123:250–259

    PubMed  CAS  Google Scholar 

  16. Coque TM, Tomayko JF, Ricke SC et al (1996) Vancomycin-resistant enterococci from nosocomial, community and animal sources in the United States. Antimicrob Agents Chemother 40:2605–2609

    PubMed  Google Scholar 

  17. Pujol M, Pena C, Pallares R et al (1996) Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 100:509–516

    Article  PubMed  CAS  Google Scholar 

  18. Sanchez-Garcia M, Cambronero-Galache JA, Lopez-Diaz J et al (1998) Effectiveness and costs 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 

  19. van der Voort PH, van der Hulst RW, Zandstra DF et al (2001) Suppression of Helicobacter pylori infection during intensive care stay: related to stress ulcer bleeding incidence? J Crit Care 16:182–187

    Article  PubMed  Google Scholar 

  20. Daschner FD, Frey P, Wolff G et al (1982) Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med 8:5–9

    Article  PubMed  CAS  Google Scholar 

  21. Rangel-Frausto MS, Pittet D, Costigan M et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 273:117–123

    Article  PubMed  CAS  Google Scholar 

  22. Source: Algemeen Nederlands Persbureau.

    Google Scholar 

  23. Fagon JY, Chastre J, Wolff M et al (2000) Invasive and non-invasive strategies for management of suspected ventilator-associated pneumonia. Ann Intern Med 132:621–630

    PubMed  CAS  Google Scholar 

  24. Canadian Critical Care Trials Group; Heyland D, Dodek P, Muscedere J et al (2006) A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 355:2619–2630

    Article  CAS  Google Scholar 

  25. de Man P, Verhoeven BA, Verbrugh HA et al (2000) An antibiotic policy to prevent emergence of resistant bacilli: Lancet 355:973–978

    Article  PubMed  Google Scholar 

  26. Wolff M (1998) Comparison of strategies using cefpirome and ceftazidime for empiric treatment of pneumonia in intensive care patients. The Cefpirome Pneumonia treatment group Antimicrob Agents Chemother 42:28–36

    CAS  Google Scholar 

  27. Brun-Buisson C, Sollet JP, Schweich H et al (1998) Treatment of ventilator-associated pneumonia with piperacillin-tazobactam/amikacin versus ceftazidime/amikacin: a multicenter, randomized controlled trial. VAP Study Group. Clin Infect Dis 26:346–354

    Article  PubMed  CAS  Google Scholar 

  28. Beaucaire G, Nicolas MH, Martin C (1999) Phare study. Comparative study of combined cefepime-amikacin versus ceftazidime combined with amikacin in the treatment of nosocomial pneumonias in ventilated patients. Multicenter group study. Ann Fr Anesth Reanim 18:186–195

    PubMed  CAS  Google Scholar 

  29. Klein BS, Perloff WH, Maki DG (1989) Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 320:1714–1721

    Article  PubMed  CAS  Google Scholar 

  30. van der Waaij D, van der Waaij JM (1985) Spread of multiresistant gram-negative bacilli among severely immuno-compromised mice during prophylactic treatment with different oral antimicrobial drugs. Prog Clin Biol Res 181:245–250

    PubMed  Google Scholar 

  31. Baines PB, Taylor N, Sarginson RE et al. (2006) Emergence of antimicrobial resistance in a paediatric intensive care unit (PICU). Pediatr Crit Care Med Suppl 3rd World Congress, book of Abstracts, 165 FP16 Infectious Diseases.

    Google Scholar 

  32. de la Cal MA, Cerda E, Calderon M et al. Oral vancomycin in the control of MRSA outbreaks in ICU. In: van Saene HKF, Sganga G, Silvestri L (eds) Infection in the critically ill: an ongoing challenge. Springer-Verlag Italia, Milan 2001, pp 139–146

    Google Scholar 

  33. Hammond JMJ, Potgieter PD (1995) Long-term effects of selective decontamination on antimicrobial resistance. Crit Care Med 23:637–645

    Article  PubMed  CAS  Google Scholar 

  34. Stoutenbeek CP, van Saene HKF, Zandstra DF (1987) The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother 19:513–520

    Article  PubMed  CAS  Google Scholar 

  35. Lingnau W, Berger J, Javorsky F et al (1998) Changing bacterial ecology during a five-year period of selective intestinal decontamination. J Hosp Infect 39:195–206

    Article  PubMed  CAS  Google Scholar 

  36. van der Voort PHJ, van Roon EN, Kampinga GA et al (2004) A before-after study of multi-resistance and cost of selective decontamination of the digestive tract. Infection 32:271–277

    Article  PubMed  Google Scholar 

  37. Viviani M, van Saene HK, Dezzoni R et al (2005) Control of imported and acquired methicillin-resistant Staphylococcus aureus (MRSA) in mechanically ventilated patients: a dose-response study of enteral vancomycin to reduce absolute carriage and infection. Anaesth Intensive Care 33:361–372

    PubMed  CAS  Google Scholar 

  38. 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 32:839–842

    Article  PubMed  CAS  Google Scholar 

  39. Heininger A, Meyer E, Schwab F et al (2006) Effects of long-term routine use of selective digestive decontamination on antimicrobial resistance. Intensive Care Med 32:1569–1576

    Article  PubMed  Google Scholar 

  40. Leone M, Albanese J, Antonini F et al (2003) Long-term (6 year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients. Crit Care Med 31:2090–2095

    Article  PubMed  Google Scholar 

  41. De la Cal MA, Cerda E, van Saene HK et al (2004) Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit. J Hosp Infect 56:175–183

    Article  PubMed  Google Scholar 

  42. Cerda E, Abella A, de la Cal MA et al (2007) Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit. A 9-year prospective study. Ann Surg 245:397–407

    Article  PubMed  Google Scholar 

  43. Tetteroo GWM, Wagenvoort JHT, Bruining HA (1994) Bacteriology of selective decontamination: efficacy and rebound colonization. J Antimicrob Chemother 34:529–544

    Article  Google Scholar 

  44. Saunders N, Hammond JMJ, Potgieter PD et al (1994) Microbiological surveillance during selective decontamination of the digestive tract (SDD). J Antimicrob Chemother 34:529–544

    Article  PubMed  CAS  Google Scholar 

  45. Silvestri L, van Saene HK (2006) Selective decontamination of the digestive tract does not increase resistance in critically ill patients: evidence from randomized controlled trials. Crit Care Med 34:2027–2029

    Article  PubMed  Google Scholar 

  46. 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(9389):1011–1016

    Article  PubMed  CAS  Google Scholar 

  47. Brun-Buisson C, Legrand P, Rauss A et al (1989) Intestinal decontamination for control of nosocomial multi-resistant-gram-negative bacilli. Ann Intern Med 110:873–881

    PubMed  CAS  Google Scholar 

  48. Damjanovic V, van Saene HK (2005) Microbial mutation as a source of polyclonality in the gut of the critically ill. J Hosp Infect 59:374–375

    Article  PubMed  CAS  Google Scholar 

  49. Taylor ME, Oppenheim BA (1991) Selective decontamination of the gastrointestinal tract as an infection control measure. J Hosp Infect 71:271–278

    Article  Google Scholar 

  50. Agusti C, Pujol M, Argerich MJ et al (2002) Short-term effect of the application of selective decontamination of the digestive tract on different body site reservoir ICU patients colonized by multi-resistant Acinetobacter baumannii. J Antimicrob Chemother 49:205–208

    Article  PubMed  CAS  Google Scholar 

  51. Al Naiemi N, Heddema ER, Bart A et al (2006) Emergence of multidrug-resistant Gramnegative bacteria during selective decontamination of the digestive tract on an intensive care unit. J Antimicrob Chemother 58:853–856

    Article  PubMed  Google Scholar 

  52. Gastinne H, Wolff M, Delatour F et al (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with non-absorbable antibiotics. N Engl J Med 326:594–599

    Article  PubMed  CAS  Google Scholar 

  53. Hammond JM, Potgieter PD, Saunders GL et al (1992) Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 340:5–9

    Article  PubMed  CAS  Google Scholar 

  54. Ferrer M, Torres A, Gonzalez J et al (1994) Utility of selective digestive decontamination in mechanically ventilated patients. Ann Intern Med 120:389–395

    PubMed  CAS  Google Scholar 

  55. Wiener J, Itokazu G, Nathan C et al (1995) A randomized, double-blind, placebo controlled trial of selective digestive decontamination in a medical, surgical intensive care unit. Clin Infect Dis 20:861–867

    PubMed  CAS  Google Scholar 

  56. Lingnau W, Berger J, Javorsky F et al (1997) Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial. J Trauma 42:687–694

    Article  PubMed  CAS  Google Scholar 

  57. Verwaest C, Verhaegen J, Ferdinande P et al (1997) Randomized controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multi-disciplinary intensive care unit. Crit Care Med 25:63–71

    Article  PubMed  CAS  Google Scholar 

  58. De la Cal MA, Cerda E, Garcia-Hierro P et al (2005) Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract: a randomized, placebocontrolled, double-blind trial. Ann Surg 241:424–430

    Article  Google Scholar 

  59. Silvestri L, van Saene HK, Milanese M et al (2004) Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial. Eur Respir J 23:921–926

    PubMed  CAS  Google Scholar 

  60. Geraci JE, Heilman FR, Nichols DR et al (1956) Some laboratory and clinical experiences with a new antibiotic, vancomycin. Mayo Clin Proc 31:564–582

    CAS  Google Scholar 

  61. Currie BP, Lemos-Filho L (2004) Evidence for biliary excretion of vancomycin into stool during intravenous therapy: potential implications for rectal colonization with vancomycin-resistant enterococci. Antimicrob Agents Chemother 48:4427–4429

    Article  PubMed  CAS  Google Scholar 

  62. Tedesco F, Markham R, Gurwith M et al (1978) Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet II/8083:226–228

    Article  Google Scholar 

  63. Arnow PM, Carandang GC, Zabner R et al (1996) Randomized controlled trial of selective bowel decontamination for prevention of infections following liver transplantation. Clin Infect Dis 22:997–1003

    PubMed  CAS  Google Scholar 

  64. Hellinger WC, Yao JD, Alvarez S et al (2002) A randomized, prospective, double-blinded evaluation of selective bowel decontamination in liver transplantation. Transplantation 73:1904–1909

    Article  PubMed  Google Scholar 

  65. Bergmans DC, Bonten MJ, Gaillard CA et al (2001) Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 164:382–388

    PubMed  CAS  Google Scholar 

  66. Gaussorgues P, Salord F, Sirodot M et al (1991) Efficacité de la décontamination digestive sur la survenue des bactériémies nosocomiales chez les patients sous ventilation méchanique et recevant des betamimétiques. Réanimation Soins Intensifs Médecin d’Urgence 7:169–174

    Google Scholar 

  67. Korinek AM, Laisne MJ, Nicolas MH et al (1993) Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebocontrolled study. Crit Care Med 21:1466–1473

    Article  PubMed  CAS  Google Scholar 

  68. Krueger WA, Lenhart FP, 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: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166:1029–1037

    Article  PubMed  Google Scholar 

  69. Pugin J, Auckenthaler R, Lew DP et al (1991) Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, doubleblind clinical trial. JAMA 265:2704–2710

    Article  PubMed  CAS  Google Scholar 

  70. Schardey HM, Joosten U, Finke U et al (1997) The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg 225:172–180

    Article  PubMed  CAS  Google Scholar 

  71. Sanchez M, Mir N, Canton R, Luque R et al (1997) The effect of topical vancomycin on acquisition, carriage and infection with methicillin-resistant Staphylococcus aureus in critically ill patients. A double-blind, randomised, placebo-controlled study. 37th ICAAC, 1997, Toronto, Canada, Abstract J-119, p. 310

    Google Scholar 

  72. Stiefel U, Paterson DL, Pultz NJ et al (2004) Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centers. Infect Control Hosp Epidemiol 25:380–383

    Article  PubMed  Google Scholar 

  73. Salgado CD, Gianetta ET, Farr BM (2004) Failure to develop vancomycin-resistant enterococci in San Francisco Bay area hospitals during 1994 to 1998. Infect Control Hosp Epidemiol 25:413–417

    Article  PubMed  Google Scholar 

  74. Hendrix CW, Hammond JMJ, Swoboda SM et al (2001) Surveillance strategies and impact of vancomycin-resistant enterococcal colonisation and infection in critically ill patients. Ann Surg 233:259–265

    Article  PubMed  CAS  Google Scholar 

  75. Slaughter S, Hayden MK, Nathan C et al (1996) A comparison of the effect of universal use of gloves and gowns with that of glove alone on acquisition of vancomycin resistant enterococci in a medical intensive care unit. Ann Intern Med 125:448–456

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Durk F. Zandstra MD, PhD (Anaesthesiologist-Intensivist) & Peter H. J. van der Voort MD, PhD, MSc (Internist-intensivist)

  2. Department of Clinical Microbiology and Infection Control, Royal Liverpool Children’s NHS Trust of Alder Hey, Liverpool, UK

    Hendrick K. F. van Saene MD, PhD

Authors
  1. Durk F. Zandstra MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hendrick K. F. van Saene MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter H. J. van der Voort MD, PhD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Peter H. J. van der Voort (Internist-intensivist) (Internist-intensivist)

  2. Department of Clinical Microbiology and Infection Control, Royal Liverpool Children’s NHS Trust of Alder Hey, Liverpool, UK

    Hendrick K. F. van Saene

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer

About this chapter

Cite this chapter

Zandstra, D.F., van Saene, H.K.F., van der Voort, P.H.J. (2008). Antimicrobial Resistance During 20 Years of Clinical SDD Research. In: van der Voort, P.H.J., van Saene, H.K.F. (eds) Selective Digestive Tract Decontamination in Intensive Care Medicine: a Practical Guide to Controlling Infection. Springer, Milano. https://doi.org/10.1007/978-88-470-0653-9_9

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0653-9_9

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0652-2

  • Online ISBN: 978-88-470-0653-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation