Selective decontamination of the digestive tract as infection prevention in the critically ill. Does it lead to resistance?
Several meta-analysis showed the efficacy of selective decontamination of the digestive tract (SDD) in the reduction of infections in critically ill patients, particularly for ventilator associated pneumonia and bloodstream infections, thereby reducing mortality and morbidity. The principle of SDD is that by means of application of non-absorbable antibiotics in the intestinal canal and oropharyngeal cavity, potentially pathogenic microorganisms are eliminated, thereby reducing the incidence of organ site infections. The endogenous anaerobic flora is preserved as a factor contributing to defence against colonization. The potential induction of antibiotic resistance (AR) due to SDD is a major concern in ICU. This review evaluates the onset of clinically relevant AR after SDD. The results of a recent meta-analysis and of several studies, which confirmed the virtual absence of any reported AR with SDD and that did not find AR after stopping SDD, are presented. The eradication of the reservoir of abnormal bacteria located in the gut by topical non-absorbable antibiotics appears to significantly reduce morbidity, mortality and resistance. Using only systemic antibiotics in ICU may contribute to maintain an abnormal population of bacteria among which AR is encouraged.
Zandstra
D F
DF
ICU Onze Lieve Vrouwe Gasthuis, Amsterdam. D.F.Zandstra@olvg.nl
van Saene
H K
HK
D000208:Acute Disease; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D002908:Chronic Disease; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination; D004064:Digestive System / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D006801:Humans; D007362:Intensive Care Units