Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials

Abstract

Antifungals, as part of selective decontamination of the digestive tract, reduce fungal carriage and infection but not fungaemia in critically ill patients and may justify the inclusion of an antifungal component in the decontamination protocol.

The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study

“…It is clear from these results that, although clinicians' knowledge of the evidence base could be improved, fear of driving antibiotic resistance is a major limiting factor that needs to be more clearly understood before clinicians will implement this regimen [7][8][9]. It is fascinating to reflect that an evidence base suggesting effectiveness in 36 RCT amassed over a 30 year period [1][2][3][4][5][6] is not compelling enough to overcome a perceived risk of driving antibiotic resistance that, to date, has not been upheld in the existing literature [7][8][9]. The interview topic guide was based on a theoretical framework of clinical behaviour [14] which ensured good coverage of potential barriers and facilitators to SDD adoption.…”

“…SDD involves the prophylactic application of topical non-absorbable antibiotics to the oropharynx and stomach with a short course of intravenous antibiotics. Despite much interest over many years and a large evidence base (36 randomised controlled studies) suggesting efficacy in reducing rates of HAIs and increasing survival [1][2][3][4][5][6][7][8][9] SDD has not been widely adopted into intensive care practice worldwide. SDD continues to be a controversial subject, and seems to receive limited support from clinicians [10,11].…”

“…The content of each of the domains is described in Table 1. The controversial nature of SDD and the uncertainty about its evidence base [1][2][3][4][5][6][7][8][9]15,16] suggests that clinicians both within and between different clinical specialities and professional groups may hold opposing views. This study therefore applied Delphi methodology to systematically assess agreement/disagreement with SDD within ICU healthcare professionals.…”

“…(2) What are the views of key stakeholders about the likely positive and negative consequences of implementing SDD in ICUs? (3) What are the views of key stakeholders about the likely barriers to implementing SDD in ICUs?…”

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

“…SDD involves four components: 1) a four day course of parenteral antibiotics to control PPMs present on admission; 2) administration non-absorbable antimicrobials (normally polymyxin E, tobramycin and amphotericin B) to the oral cavity and gastrointestinal tract; 3) continuation of standard hygiene measures to control exogenous infections; and 4) cultures of the throat and rectum on admission and then twice weekly to assess the efficacy of SDD and identify emergence of resistant bacteria. (Liberati et al, 2004, Silvestri et al, 2005 SDD is one intervention that, when fully implemented, has been shown to prevent VAP and improve survival (de Smet et al, 2009, van Essen andde Jonge, 2011), yet uptake into clinical practice is not widespread internationally and only one evidence-based guideline on the prevention of VAP recommends that SDD be considered for patients ventilated for more than 48 hours. (Masterton et al, 2008) Despite some uncertainty about the effectiveness of SDD and perceived risk of increased antimicrobial resistance, it is quite possible that critical care nurses will be required to implement SDD, where implementation includes four overlapping processes of adoption, operationalision, provision and surveillance.…”