[Selective digestive decontamination: the light as changed from red to green].
OBJECTIVE
To study the efficacy of selective digestive decontamination (SDD) for the prevention of nosocomial infections, particularly pneumonia, as well as its impact on the emergence of multiresistant bacteria.


METHODS
Data collected from the Pubmed: original articles, review articles and editorial published on SDD. The keywords were: selective digestive decontamination, pneumonia, intensive care unit, infection.


METHODS
Ten randomized clinical trials performed since 1995 in mechanically ventilated adult patients hospitalized in intensive care unit.


RESULTS
The rationale for the use of SDD consists on the parenteral administration of a short course of antibiotic associated with the topical use of non-absorbable antibiotics directed against Gram negative bacteria. Five randomized studies described a reduction in the incidence of pneumonia associated with SDD. Only one study has showed a decrease in mortality rate. The other five studies, which present some methodological limitations, concluded the lack of efficacy of SDD. Regarding the emergence of multiresistant bacteria, the literature underlines the role of environment. The use of SDD seems to trigger the resistance in endemic areas, while these are softened in the units with a good control of their ecology.


CONCLUSIONS
The data from the literature provide arguments to use SDD in targeted patient populations like multiple traumas in intensive care units, which have a low rate of multiresistant bacteria.
Textoris
J
J
Département d'anesthésie-réanimation, centre hospitalier universitaire Nord, 13015 Marseille, France. julien.textoris@free.fr
Leone
M
M
Boyle
W A
WA
Martin
C
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004064:Digestive System / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007362:Intensive Care Units; D011014:Pneumonia / Q000382:microbiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial
D000900:Anti-Bacterial Agents