Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality

Abstract

Selective decontamination of the digestive tract (SDD) has been subject of numerous randomized controlled trials in critically ill patients. Almost all clinical trials showed SDD to prevent pneumonia. Nevertheless, SDD has remained a controversial strategy. One reason for why clinicians remained reluctant to implement SDD into daily practice could be that mortality was reduced in only 2 trials. Another reason could be the heterogeneity of trials of SDD. Indeed, many different prophylactic antimicrobial regimes were tested, and dissimilar diagnostic criteria for pneumonia were applied amongst the trials. This heterogeneity impeded interpretation and comparison of trial results. Two other hampering factors for implementation of SDD have been concerns over the risk of antimicrobial resistance and fear for escalation of costs associated with the use of prophylactic antimicrobials. This paper describes the concept of SDD, summarizes the results of published trials of SDD in mixed medical-surgical intensive care units, and rationalizes the risk of antimicrobial resistance and rise of costs associated with this potentially life-saving preventive strategy.

A Randomized, Double-Blind, Placebo-Controlled Trial of Selective Digestive Decontamination Using Oral Gentamicin and Oral Polymyxin E for Eradication of Carbapenem-Resistant Klebsiella pneumoniae Carriage

“…8 Although failure to apply any of the 4 components might reduce the effectiveness of SDD, this has been neither tested nor proven. 10 However, the aim of our pilot study was to determine the effectiveness of our regimen in eradicating rectal CRKP carriage and not in reducing and/or controlling infection. Therefore, we chose to exclude parenteral gentamicin and polymyxin E from our SDD protocol.…”

Vancomycin for methicillin-resistant staphylococcus aureus biofilm eradication is associated with the emergence of heterogeneous vancomycin intermediate staphylococcus aureus

“…The efficacy of local antibiotics in treating MRSA infections has been extensively studied, yet their clinical application remains limited. One issue impeding its clinical implementation is the concern of increasing resistance rates due to the use of high doses of local antibiotics (Haas and Schultz, 2010). In this study, the authors attempted to eradicate MRSA biofilms by subjecting them to vancomycin and evaluating the effectiveness of eradication as well as the effect of in vitro exposure on the emergence of hVISA/VISA isolates.…”