Review of available trials of selective decontamination of the digestive tract (SDD).
Eighteen studies on Selective Decontamination of the Digestive Tract (SDD) have been published up to now. A statistically significant reduction of infection rate was found in fourteen out of the fifteen controlled studies. Although all the studies were designed to evaluate infection-related morbidity as the end point, ten centres have reported fatality rates. Six centres out of the ten showed a statistically significant reduction in mortality in patients receiving SDD versus control. A recent French study describes the eradication of an outbreak of a multi-resistant Klebsiella with SDD. The Paris trial suggests a major impact of the SDD maneuver on the ICU ecology. Emergence of resistance to the SDD agents among gram-positive cocci has been described, although the clinical impact of this antibiotic side effect has not been reported so far. There are three indications for SDD, as follows: (i) trauma patients; (ii) liver transplant recipients and (iii) outbreaks of multi-resistant organisms.
Department of Medical Microbiology, University of Liverpool, UK.
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HK
van Saene
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Stoutenbeek
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Gilbertson
D003666:Decontamination / Q000379:methods*; D004064:Digestive System / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D006801:Humans; D007362:Intensive Care Units