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Selective decontamination of the digestive tract in intensive care

Published online by Cambridge University Press:  15 May 2009

S. J. Boom  and
G. Ramsay
S. J. Boom
Affiliation:
University Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT
G. Ramsay*
Affiliation:
University Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT
*
*Correspondence and reprints: Mr G. Ramsay.
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Summary

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Nosocomial infection in intensive care unit (ICU) practice is a common problem and is associated with abnormal carriage of Gram-negative aerobic bacilli in the gastrointestinal tract, resulting in endogenous infections. Selective decontamination of the digestive tract (SDD) is a regimen aimed at preventing or eradicating this abnormal carriage.

A large number of trials examining SDD in ICU practice have been published, the vast majority showing a significant reduction in the incidence of nosocomial, Gram-negative infection. However, the impact on morbidity and mortality is much less certain. A recent meta-analysis has suggested a 10–20% reduction in mortality (3–6% absolute difference) with SDD. A discussion of these results is presented together with potential criticisms of SDD.

Type
Research Article
Information
Epidemiology & Infection , Volume 109 , Issue 3 , December 1992 , pp. 337 - 347
Copyright
Copyright © Cambridge University Press 1992

References

REFERENCES

1.Thorp, JM, Richards, WC, Telfer, ABM. A survey of infection in an intensive care unit. Anaesthesia 1979; 68: 457–67.Google Scholar
2.Northey, D, Adess, ML, Hartsnek, JM, Rhoades, ER. Microbial surveillance in a surgical intensive care unit. Surg Gynecol Obstet 1974; 139: 321–5.Google Scholar
3.Stoutenbeek, CP, van Saene, HKF, Miranda, DR, Zandstra, DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 1984; 10: 185–92.CrossRefGoogle ScholarPubMed
4.van Saene, HKF, Stoutenbeek, CP, Hart, CA. Selective decontamination of the digestive tract (SDD) in intensive care patients: a critical evaluation of the clinical, bacteriological and epidemiological benefits. J Hosp Infection 1990; 18: 261–77.CrossRefGoogle Scholar
5.Wenzel, RP, Thompson, RL, Landry, SM, et al. Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 1983; 4: 371–5.CrossRefGoogle ScholarPubMed
6.Potgieter, PD, Linton, DM, Oliver, S, Forder, AA. Nosocomial infections in a respiratory intensive care unit. Crit Care Med 1987; 15: 495–8.CrossRefGoogle Scholar
7.Flynn, DM, Weinstein, RA, Nathan, C, Gaston, MA, Kabins, SA. Patients' endogenous flora as the source of nosocomial Enterobacter in cardiac surgery. J Infect Dis 1987; 156: 363–8.CrossRefGoogle Scholar
8.du Moulin, GC, Paterson, DG, Hedley-Whyte, J, Lisbon, A. Aspiration of gastric bacteria in antacid-treated patients: frequent cause of postoperative colonisation of the airway. Lancet 1982; i: 242–5.CrossRefGoogle Scholar
9.van Saene, HKF, Stoutenbeek, CP, Miranda, DR, Zandstra, DF. A novel approach to infection control in the intensive care unit. Acta Anaesthesiol Belg 1983; 34: 193–208.Google ScholarPubMed
10.Boom, SJ, Ramsay, G. Selective decontamination of the digestive tract: theoretical and practical treatment recommendations. Drugs 1991; 42: 541–50.CrossRefGoogle ScholarPubMed
11.Ledingham, IMcA, Alcock, SR, Eastaway, AT, et al. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1988; i: 785–90.CrossRefGoogle Scholar
12.Alcock, SR. Short-term parenteral antibiotics use as a supplement to SDD regimens. Infection 1990; 18 (suppl 1): S14–18.CrossRefGoogle ScholarPubMed
13.van Saene, JJM, van, Saene HKF, Stoutenbeek, CP, Lerk, CF. Influence of faeces on the activity of antimicrobial agents use for decontamination of the alimentary canal. Scand J Infect Dis 1985; 17: 295–300.CrossRefGoogle ScholarPubMed
14.Alcock, SR, Cole, DS. Selective decontamination of the digestive tract (SDD), ICU-acquired pneumonia and selection of antibiotic-resistant bacteria. J Hosp Infect 1990; 15: 195–7.CrossRefGoogle ScholarPubMed
15.Jones, WG, Barie, PS, Yurt, RW, et al. Enterococcal burn sepsis: a highly lethal complication in severely burned patients. Arch Surg 1986; 121: 649–53.CrossRefGoogle ScholarPubMed
16.Dougherty, SH, Flohr, AB, Simmons, RL. ‘Breakthrough’ enterococcal septicaemia in surgical patients: 19 cases and a review of the literature. Arch Surg 1983; 118: 232–8.CrossRefGoogle Scholar
17.Flaherty, J, Nathan, C, Kabins, SA, Weinstein, RA. Pilot trial of selective decontamination for prevention of bacterial infection in an ICU. J Infect Dis 1990; 162: 1393–7.CrossRefGoogle Scholar
18.Unertl, K, Ruckdeschel, G, Selbmann, HK, et al. Prevention of colonisation and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 1987; 13: 106–13.CrossRefGoogle ScholarPubMed
19.Dobb, GJ, Boyle, SM. The effect of selective decontamination of the digestive tract (SDD) on nosocomial pneumonia and mortality in an Australian intensive care unit (abstract). Clinical Intensive Care 1992; v3 (suppl 2): 1.Google Scholar
20.Daschner, F. Nosocomial infections in intensive care units. Intensive Care Med 1985; 11: 284–7.CrossRefGoogle ScholarPubMed
21.Donowitz, LG, Wenzel, RP, Hoyt, JW. High risk of hospital-acquired infection in the ICU patient. Crit Care Med 1982; 10: 355–7.CrossRefGoogle ScholarPubMed
22.Brown, RB, Hosmer, D, Chen, HC, et al. A comparison of infections in different ICUs within the same hospital. Crit Care Med 1985; 13: 472–6.CrossRefGoogle ScholarPubMed
23.Rayfield, EJ, Ault, MJ, Keusch, GT, Brothers, MJ, Nechemias, C, Smith, H. Infection and diabetes: the case for glucose control. Am J Med 1982; 72: 439–50.CrossRefGoogle ScholarPubMed
24.van Epps, DE, Strickland, RG, Williams, RC. Inhibitors of leukocyte chemotaxis in alcoholic liver disease. Am J Med 1975; 59: 200–7.CrossRefGoogle ScholarPubMed
25.Dionigi, R, Zonta, A, Diminioni, L, Gnes, F, Ballabio, A. The effects of total parenteral nutrition on immuno-depression due to malnutrition. Ann Surg 1977; 185: 467–74.CrossRefGoogle Scholar
26.Christou, NV, McLean, APH, Meakins, JL. Host defence in blunt trauma: interrelationships of kinetics of anergy and depressed neutrophil function, nutritional status and sepsis. J Trauma 1980; 20: 833–41.CrossRefGoogle ScholarPubMed
27.Howard, RJ, Simmons, RL. Acquired immunologic deficiencies after trauma and surgical procedures. Surg Gynecol Obstet 1974; 139: 771–82.Google ScholarPubMed
28.Munster, AM. Post-traumatic immunosuppression is due to activation of suppressor T cells. Lancet 1976; i: 1329–30.CrossRefGoogle Scholar
29.Ninnemann, JL, Condie, JT, Davis, SE, Crockett, RA. Isolation of immunosuppressive serum components following thermal injury. J Trauma 1982; 22: 837–44.CrossRefGoogle ScholarPubMed
30.van Dijk, WC, Verbrugh, HA, vanRijswijk, REN, VosA, Verhoef J. Neutrophil function, serum opsonic activity, and delayed hypersensitivity in surgical patients. Surgery 1982; 92: 21–9.Google ScholarPubMed
31.Kerver, AJH, Rommes, JH, Mevissen-Verhage, EAE, et al. Prevention of colonisation and infection in critically ill patients: a prospective randomised study. Crit Care Med 1988; 16: 1087–93.CrossRefGoogle Scholar
32.Langer, M, Cigada, M, Mandelli, M, et al. Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 1987; 13: 342–6.CrossRefGoogle ScholarPubMed
33.Cross, AS, Roup, B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981; 70: 681–5.CrossRefGoogle ScholarPubMed
34.Janson, BS, Poulton, TJ. Does peep reduce the incidence of aspiration around endotracheal tubes? Can Anaesth Soc J 1986; 33: 157–61.CrossRefGoogle ScholarPubMed
35.Landa, JF, Kwoka, MA, Chapman, GA, Brito, M, Sackner, MA. Effects of suctioning on mucociliary transport. Chest 1980; 77: 202–7.CrossRefGoogle ScholarPubMed
36.Atherton, ST, White, DJ. Stomach as a source of bacteria colonising respiratory tract during artificial ventilation. Lancet 1978; ii: 968–9.CrossRefGoogle Scholar
37.Mehta, S, Archer, JF, Mills, J. pH dependent bactericidal barrier to Gram-negative aerobes: its relevance to airway colonisation and prophylaxis of acid aspiration and stress ulcer syndromes - study in vitro. Intensive Care Med 1986; 12: 134–6.CrossRefGoogle ScholarPubMed
38.Garvey, BM, McCambley, A, Tuxen, DV. Effects of gastric alkalization on bacterial colonization in critically ill patients. Crit Care Med 1989; 17: 211–16.CrossRefGoogle ScholarPubMed
39.Hillman, KM, Riordan, TO'Farrell, SM, Tabaqchali, S. Colonisation of the gastric contents in critically ill patients. Crit Care Med 1982; 10: 444–7.CrossRefGoogle ScholarPubMed
40.Hoyt, JW. Nosocomial pneumonia. Anesth Clinics N Am 1989; 7: 869–81.CrossRefGoogle Scholar
41.Fiddian-Green, RG, Baker, S. Nosocomial pneumonia in the critically ill: product of aspiration or translocation. Crit Care Med 1991; 19: 763–9.CrossRefGoogle ScholarPubMed
42.Sprunt, K, Redman, W. Evidence suggesting importance of role of interbacterial inhibiton in maintaining balance of normal flora. Ann Intern Med 1968; 68: 579–90.CrossRefGoogle Scholar
43.van der, Waaij D, Berghuis-Devries, JM, Lekkerkerk-van der, Wees JAC. Colonisation resistance of the digestive tract in conventional and antibiotic treated mice. J Hyg 1971; 69: 405–11.CrossRefGoogle Scholar
44.Marshall, JC. The ecology and immunology of the gastrointestinal tract in health and critical illness. J Hosp Infection 1991; 19 (suppl C): 7–17.CrossRefGoogle ScholarPubMed
45.Nyström, B, Frederici, H, von Euler, C. Bacterial colonization and infection in an intensive care unit. Intensive Care Med 1988; 14: 34–8.CrossRefGoogle Scholar
46.Fagon, JY, Chastre, J, Domart, Y, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 1989; 139: 877—84.CrossRefGoogle ScholarPubMed
47.Godard, J, Guillaume, C, Reverdy, M-E, et al. Intestinal decontamination in a polyvalent ICU. Intensive Care Med 1990; 16: 307–11.CrossRefGoogle Scholar
48.Geddes, DM. Infection v. colonisation. Intensive Care Med 1990; 16 (suppl 3): S201–5.CrossRefGoogle ScholarPubMed
49.Hünefeld, VG. Klinische Studie zur selectiven Darmdekolonisation bei 204 langzeitbeatmeten abdominal- und unfallchirurgischen Intensivpatienten. Anasthesiol Reanimat 1989; 14: 131–53.Google Scholar
50.Ulrich, C, Harinck-de, Weerd JE, Bakker, NC, et al. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989; 15: 424–31.CrossRefGoogle ScholarPubMed
51.Schardey, M, Meyer, G, Kern, M, et al. Nosocomial respiratory tract infections: preventive measures in surgical intensive care patients (English abstract translation). Intensivmedizin 1989; 26: 242–9.Google Scholar
52.Blair, P, Rowlands, BJ, Lowry, K, Webb, H, Armstrong, P, Smilie, J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 1991; 110: 303–10.Google Scholar
53.Cerra, FB, Maddaus, MA, Dunn, DL, et al. Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care patients. Arch Surg 1992; 127: 163–9.CrossRefGoogle Scholar
54.Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidem 1989; 129: 1258–67.CrossRefGoogle ScholarPubMed
55.Yandenbrouke-Grauls, CMJE, Yandenbrouke, JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 1991; 338: 859–62.CrossRefGoogle Scholar
56.Liberati, A, Brazzi, L. Effect of selective decontamination of the digestive tract (SDD) upon mortality. Abstracts book: selective decontamination of the digestive tract in ICU patients: first European consensus conference of intensive care medicine. 12 1991, Paris.Google Scholar
57.Brun-Buisson, G, Legrand, P, Rauss, A, et al. Intestinal decontamination for control of nosocomial multi-resistant Gram-negative bacilli. Ann Intern Med 1989; 110: 873–81.CrossRefGoogle Scholar
58.Casewell, MW, Phillips, I. Aspects of the plasmid-mediated antibiotic resistance and epidemiology of Klebsiella species. Am J Med 1981; 70: 459–62.CrossRefGoogle ScholarPubMed
59.Taylor, ME, Oppenheim, BA. Selective decontamination of the gastrointestinal tract as an infection control measure. J Hosp Infect 1991; 17: 271–8.CrossRefGoogle ScholarPubMed
60.Meakins, JL, Marshall, JC. The gastrointestinal tract: the ‘motor’ of multiple organ failure. Arch Surg 1986; 121: 197–201.Google Scholar
61.van Saene, JJM, Stoutenbeek, CP, van Saene, HKF. Significant reduction of faecal endotoxin pool by oral polymyxin E and tobramycin in human volunteers. In: van Saene, HKF, Stoutenbeek, CP, Lawin, P, Ledingham, IMcA, eds. Infection control in ICLT by SDD. Heidelberg: Springer Yerlag, 1989: 128–34.Google Scholar
62.Bleichrodt, RB, Rosman, C, Wubbolts, G, Manson, W. Prevention of bacterial translocation and endotoxaemia in rats with zymosan induced peritonitis by selective decontamination (abstract). Surg Res Comm 1990; 8: 17.Google Scholar