Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality
نویسندگان
چکیده
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.
منابع مشابه
Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence.
OBJECTIVE To determine the comparative efficacy of selective decontamination of the digestive tract in critically ill surgical and medical patients, and in selected subgroups of surgical patients with pancreatitis, major burn injury, and those undergoing major elective surgery and transplantation. DATA SOURCES The MEDLINE database was searched from January 1966 to December 1996 using the term...
متن کاملSelective digestive decontamination is superior to selective oropharyngeal decontamination
are interested in the debate on the effi cacy and safety of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) raised by Schultz and Haas in their review [1]. Th e authors concluded that 'SDD and SOD are equally eff ective with respect to the prevention of mortality' [1]. Th is statement is based on the results of a Dutch randomized controlled trial [2],...
متن کاملSelective decontamination of the digestive tract.
Ventilator-associated pneumonia usually originates from the patient's oropharyngeal microflora. In selective digestive decontamination, topical antibiotics are applied to the oropharynx and stomach for prevention of pneumonia and other infections, possibly reducing infection-related mortality. Selective digestive decontamination is also used for the prevention of gut-derived infections in acute...
متن کاملSelective decontamination of the digestive tract in critically ill children: systematic review and meta-analysis.
OBJECTIVE We examined the impact of selective decontamination of the digestive tract on morbidity and mortality in critically ill children. DATA SOURCES We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and previous meta-analyses. STUDY SELECTION We included all randomized controlled trials comparing administration of enteral antimicrobials in selective decontaminatio...
متن کاملSelective decontamination of the digestive tract reduces mortality in critically ill patients
Several emotional responses may be invoked in critical care physicians when confronted with selective decontamination of the digestive tract (SDD). Although recent meta-analyses have shown that the use of SDD reduces the occurrence of ventilator-associated pneumonia and improves ICU survival, the effectiveness of SDD has remained controversial. We recently concluded a large randomized, controll...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
دوره 2010 شماره
صفحات -
تاریخ انتشار 2010