Seminars in respiratory infections
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Semin Respir Infect · Dec 1993
ReviewSelective decontamination of the digestive tract: risks outweigh benefits for intensive care unit patients.
Selective decontamination of the digestive tract (SDD) involves the administration of non-absorbable antibiotics (+/- a systemic antibiotic) to prevent colonization and infection in intensive care unit patients. The regimen is targeted at nosocomial gram-negative bacilli, some gram-positive bacteria and yeast. ⋯ To date, there is conflicting evidence that SDD significantly reduces length of stay, mortality, or hospital costs. Currently, there are concerns that SDD may result in increased colonization and infection with gram-positive organisms and multi-drug resistant pathogens, particularly in medical ICU patients or when used for extended periods of time.
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Semin Respir Infect · Dec 1993
ReviewIndications for selective decontamination of the digestive tract.
Controversy exists as to the utility of selective decontamination of the digestive tract (SDD) as a method of infection prevention in critically ill patients. A number of prospective randomly controlled studies and 2 meta-analyses have shown a statistically significant protective effective of SDD against nosocomial infection. Most other SDD trials have shown reductions in nosocomial infections, but these reductions have not been statistically significant. ⋯ SDD may be an effective infection prevention method in intensive care units in which there is a high rate of nosocomial pneumonia and/or other infections and in the postoperative period of orthotopic liver transplantation. SDD may also be useful to eliminate resistant gram-negative bacilli colonizing patients who are at high risk for infection sequelae. When SDD is used, periodic surveillance for the emergence of resistant microorganisms is imperative.