Abstract
In the course of a prospective selective digestive decontamination (SDD) trial to prevent nosocomial pneumonia (NP) during mechanical ventilation (MV), we carried out serial cultures of gastric aspirate to assess the importance of gastric colonization for potential respiratory pathogens and its relationship to the simultaneous gastrich pH, to whether the patients were receiving Sucralfate or Ranitidine and to the nutritional biochemical parameters. If NP developed, a bronchial sample was taken by fibreoptic bronchoscopy to determine the causal organisms and its relationship to the previous gastric isolated. Results show: 1) Increase in aerobic Gran negative bacilli colonization during hospitalization. 2) Direct relationship between colonization level and gastric pH. 3) Greater pH in ranitidine vs suscralfate group. 4) Low incidence of NP (11%), the majority of these (66%) being early. 5) No bacteriological correlation between gastric colonization and aetiological agents of NP. 6) Close relationship between pharyngeal colonization and causative germs of pulmonary infection (40%).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Atherton ST, White DJ (1978) Stomach as a source of bacteria colonising respiratory tract during artificial ventilation. Lancet II:968–969
Kerver AJH, Rommes JH, Mevissen EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1987) Colonization and infection in surgical intensive care patients: a prospective study. Intensive Care Med 13:347–351
Pingleton SK (1989) Enteral nutrition as a risk factor for nosocomial pneumonia. Eur J Clin Microbiol Infect Dis 8:51–55
Rodriguez JM, Altuna A, Lopez A, Garcia J, Carrillo A, Leon J, Martinez Pellus AE (1990) Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 18:1239–1242
Garvey BM, McCambley JA, Tuxen DV (1989) Effects of gastric alkylinization on bacterial colonization in critically ill patients. Crit Care Med 17:211–216
Pingleton SK, Hinthorn DR, Liu CH (1986) Enteral nutrition in patients receiving mechanical ventilation: multiple sources of tracheal colonization includes the stomach. Am J Med 80:827–832
du Moulin GC, Hedley-Whyte J, Paterson DG, Lisbon A (1982) Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway. Lancet I:242–245
Reusser P, Zimmerli W, Scheidegger D, Marbet GA, Buser M, Gyr K (1989) Role of gastric colonization in nosocomial infections and endotoxemia: a prosprective study in neurosurgical patients on mechanical ventilation. J Infect Dis 160:414–421
Stoutenbeck CP, Van Saene HKF, Miranda DR (1987) The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357–364
Meakins JL, Marshall JC (1986) The gastrointestinal tract: the motor of multiple organ failure. Arch Surg 121:197–201
Ramsay G, Ledingham IMcA (1989) Management of multiple organ failure: control of the microbial environment In: Bihari DJ, Cerra FD (eds) Multiple organ failure. New Horizons Series: No 3. Society of Critical Care Medicine, Fullarton, California
Donowitz GL, Page ML, Mileur BL, Guenthner SH (1986) Alteration of normal gastric flora in critical care patients receiving antacids and cimetidine therapy. Infect Control 7:23–26
Daschner F, Kappstein I, Engels I, Reuschenbach K, Pfisterer J, Krieg N, Vogel W (1988) Stress ulcer phrophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents. Infect Control Hosp Epidemia 9:59–65
Goularte TA, Lichtenberg DA, Craven DE (1986) Gastric colonization in patients receiving antacids and mechanical ventilation: a mechanism for pharyngeal colonization. Am J Infect Control 14:88–90
Tryba M, Zevounou F, Torok M, Zenz M (1985) Prevention of acute stress bleeding with Sucralfate, antacids or cimetidine. Am J Med 79 (Suppl 2 c):55–61
Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GA, Kunches LM, Farber HW, Wedel SA, McCabe WR (1987) Nosocomial pneumonia in intubated patients given Sucralfate as compared with antacids or histamine type H2 blockers. N Engl J Med 317:1376–1382
Hillman KM, Riordan T, O'Farrell SM, Tabaqchali S (1982) Colonization of the gastric contents in critically ill patients. Crit Care Med 10:444–447
Martinez Pellus AE, Alvarez B, Melgarejo A, Palacios F, Calvo R and Study group of Nosocomial Pneumonia (1990) Etiologia de la NN en Cuidados Intensivos. Factores predisponentes. Med Intensiva 14:413–416
Craven DE, Daschner FD (1989) Nosocomial pneumonia in the intubated patients: role of gastric colonization. Eur J Clin Microbiol Infect Dis 8:40–50
Stevens RM, Teres D, Skillman JJ, Feingold DS (1974) Pneumonia in an intensive care unit: a thirty-month experience. Arch Intern Med 134:106–111
Craven DE, Kunches LM, Killinsky V, Lichtenberg DA, Make BJ, McCabe WR (1986) Risk factor for neumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 133:792–796
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Martinez-Pellús, A.E., Ruiz, J., Garcia, J. et al. Role of selective digestive decontamination (SDD) in the prevention of nosocomial pneumonia (NP): Is gastric decontamination necessary?. Intensive Care Med 18, 218–221 (1992). https://doi.org/10.1007/BF01709835
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709835