Skip to main content
SpringerLink
Log in

Review of available trials of selective decontamination of the digestive tract (SDD)

Selektive Dekontamination des Verdauungstraktes (SDD)

  • Review
  • Published:
Infection Aims and scope Submit manuscript

Summary

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-resistantKlebsiella 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.

Zusammenfassung

Übersicht über publizierte Studien. Bisher wurden 18 Studien über selektive Darmdekontamination (SDD) publiziert. In 14 der 15 unter kontrollierten Bedingungen durchgeführten Untersuchungen wurde eine statistisch signifikante Reduktion der Infektionsraten gefunden. Obwohl sämtliche Studien die Feststellung der infektionsbezogenen Morbidität zum Ziel hatten, wurden von zehn Zentren Mortalitätsraten mitgeteilt. In sechs dieser zehn Publikationen wurde eine statistisch signifikante Abnahme der Mortalität nachgewiesen. Eine kürzlich veröffentlichte französische Arbeit beschreibt die Kontrolle einer Endemie mit multiresistentenKlebsiella spp. mittels SDD. Das Ergebnis dieser Pariser Studie ist möglicherweise die Folge einer klinisch relevanten Beeinflussung der Mikroflora auf der Intensivtherapiestation durch SDD. Unter SDD sind Resistenzentwicklungen von grampositiven Kokken beschrieben worden; über die klinische Bedeutung dieses Phänomens wurde jedoch nicht berichtet. Es existieren drei Indikationen für SDD: 1. polytraumatisierte Patienten; 2. lebertransplantierte Patienten; 3. Endemien mit multiresistenten Mikroorganismen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. van Saene, H. K. F., Stoutenbeek, C., P., Zandstra, D. F.: Concept of selective decontamination of the digestive tract in the critically ill. In:van Saene, H. K. F., Stoutenbeek, C. P., Lawin, P., McA. Ledingham, I. (eds.): Infection control by selective decontamination. Springer Verlag 1989, pp. 88–94.

  2. van Saene, H. K. F., Stoutenbeek, C. P., Stoller, J. K.: Selective decontamination of the digestive tract (SDD) in ICU: Current status and future prospects. Crit. Care Med. (1990) in press.

  3. Guiot, H. F. L., van der Meer, J. W. M., van Furth, R. Selective antimicrobial modulation of human microbial flora: infection prevention in patients with decreased host defense mechanisms by selective elimination of potentially pathogenic bacteria. J. Infect. Dis. 143 (1981) 644–654.

    Google Scholar 

  4. van Saene, J. J. M., van Saene, H. K. F., Stoutenbeek, C. P., Lerk, C. F. Influence of faeces on the activity of antimicrobial agents used for decontamination of the alimentary canal. Scand. J. Infect. Dis. 17 (1985) 295–300.

    Google Scholar 

  5. van Saene, J. J. M., van Saene, H. K. F., Tarko-Smith, N. J. Ph., Beukeveld, G. J. J. Enterobacteriaceae suppression by three different oral doses of polymyxin E in human volunteers. Epidem. Infect. 100 (1988) 407–417.

    Google Scholar 

  6. Carlet, J.: Consensus Confrence Paris. Diagnostic des pneumopathies nosocomiales en réanimation. Réanimation Soins Intensifs Médicine d'Urgence (1990) in press.

  7. Stoutenbeek, C. P., van Saene, H. K. F., Miranda, D. R., Zandstra, D. F., Langrehr, D. The effect of oropharyngeal decontamination using topical non-absorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J. Trauma 27 (1987) 357–364.

    Google Scholar 

  8. Huxley Miller, E., Caplan, E. S. Nosocomial hemophilus pneumonia in patients with severe trauma. Surg. Gynecol. Obstet. 159 (1984) 153–156.

    Google Scholar 

  9. Weinstein, L., Goldfield, M., Chang, T. W. Infection occurring during chemotherapy. A study of their frequency, type and predisposing factors. N. Engl. J. Med. 251 (1954) 247–255.

    Google Scholar 

  10. Stoutenbeek, C. P., van Saene, H. K. F., Miranda, D. R., Zandstra, D. F., Binnendijk, B. The prevention of superinfection in multiple trauma patients. J. Antimicrob. Chemother. 14 (Suppl. B) (1984) 203–211.

    Google Scholar 

  11. Stoutenbeek, C. P., van Saene, H. K. F.: How to improve infection prevention by selective decontamination of the digestive tract (SDD). Infection (this issue) (1990).

  12. Retailliau, H. F., Hightower, A. W., Dixon, R. E., Allen, J. R. Acinetobacter calcoaceticus: a nosocomial pathogen with an unusual seasonal pattern. J. Infect. Dis. 139 (1979) 371–375.

    Google Scholar 

  13. Tullus, K., Burman, L. G. Ecological impact of ampicillin and cefuroxime in neonatal units. Lancet i (1989) 1405–1407.

    Google Scholar 

  14. Kerver, A. J. H., Rommes, J. H., Mevissen-Verhage, E. A. E., Hulstaert, P. F., Vos, A., Verhoef, J. Colonization and infection in surgical intensive care patients — a prospective study. Intensive Care Med. 13 (1987) 347–351.

    Google Scholar 

  15. Gross, P. A., van Antwerpen, C. Nosocomial infections and hospital deaths. A case control study. Amer. J. Med. 75 (1983) 658–662.

    Google Scholar 

  16. Dekker, A. W., Rozenberg-Arska, M., Sixma, J. J., Verhoef, J. Prevention of infection by trimethoprim — sulfamethoxazole plus amphotericin B in patients with acute non lymphoblastic leukaemia. Ann. Intern. Med. 95 (1981) 555–559.

    Google Scholar 

  17. Lacroix, J., Infante-Rivard, C., Jenicek, M., Gauthier, M. Prophylaxis of upper gastrointestinal bleeding in intensive care units: A meta-analysis. Crit. Care Med. 17 (1989) 862–869.

    Google Scholar 

  18. Feeley, T. W., du Moulin, G. C., Hedley-Whyte, J., Bushnell, L. S., Gilbert, J. P., Feingold, D. S. Aerosol polymyxin and pneumonia in seriously ill patients. N. Engl. J. Med. 293 (1975) 471–475.

    Google Scholar 

  19. Weinstein, R. A. Selective intestinal decontamination — an infection control measure whose time has come? Ann. Intern. Med. 110 (1989) 853–854.

    Google Scholar 

  20. Daschner, F. Selektive Dekontamination auf Intensivstationen? Der Anästhesist 36 (1987) 696–697.

    Google Scholar 

  21. Daschner, F. Cefotaxim-Resistenz bei selektiver Dekontamination des Verdauungstraktes. Arznei Telegramm 5 (1989) 49–50.

    Google Scholar 

  22. Kappstein, I., Daschner, F. Resistenzentwicklung bei selektiver Darmdekontamination. Deutsches Ärzteblatt 41 (1989) 2073–2074.

    Google Scholar 

  23. Langer, M., Mosconi, P., Cigada, M., Mandelli, M., andICU group of infection control Long-term respiratory support and risk of pneumonia in critically ill patients. Am. Rev. Resp. Dis. 140 (1984) 302–305.

    Google Scholar 

  24. van Saene, H. K. F., Stoutenbeek, C. P., Zandstra, D. F. Cefotaxime combined with selective decontamination in long-term intensive care unit patients. Virtual absence of emergence of resistance. Drugs 35 (Suppl. 2) (1988) 29–34.

    Google Scholar 

  25. Daschner, F. Cost-effectiveness in hospital infection control. Lessons for the 1990s. J. Hosp. Inf. 13 (1989) 325–326.

    Google Scholar 

  26. Craven, D. E., Daschner, F. D. Nosocomial pneumonia in the intubated patient: role of gastric colonization. Eur. J. Clin. Microbiol. and Infect. Dis. 8 (1989) 40–50.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Microbiology, University of Liverpool, P.O. Box 147, L69 3BX, Liverpool, UK

    H. K. F. van Saene M.D., Ph.D.

  2. Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, 1ste Oosterparkstraat 179, NL-1091-HA, Amsterdam, The Netherlands

    C. P. Stoutenbeek M.D., Ph. D.

  3. Department of Intensive Care, Royal Liverpool Hospital, Prescot Street, L7 8XW, Liverpool, UK

    A. A. Gilbertson MB.Ch.B.FFARCS.

Authors
  1. H. K. F. van Saene M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. P. Stoutenbeek M.D., Ph. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. A. Gilbertson MB.Ch.B.FFARCS.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Saene, H.K.F., Stoutenbeek, C.P. & Gilbertson, A.A. Review of available trials of selective decontamination of the digestive tract (SDD). Infection 18 (Suppl 1), S5–S9 (1990). https://doi.org/10.1007/BF01644479

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01644479

Keywords

Search

Navigation