Effect of selective flora suppression on colonization, infection, and mortality in critically ill patients

Prophylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection?

“…In most instances, colonization of the gastrointestinal and respiratory tracts with pathogenic gramnegative bacteria precedes the development of infection in these patients. As an approach to prevent this progression from colonization through infection, the use of topical nonabsorbable antibiotics to selectively decontaminate the digestive tract (SDD) has been evaluated in 14 studies with historic controls (7,18,21,23,31,33,36,37,50,(52)(53)(54)63) and 26 studies with concurrent controls (1, 3, 4, 7, 9, 10, 15, 19, 22, 25, 27, 29, 32, 38, 42, 44-46, 49, 54-56, 58, 63, 65).A meta-analysis based on 22 randomized studies (4,142 patients) reported convincing evidence of a favorable effect of SDD on the incidence of respiratory infection (RI) with a reduction of approximately 63% (51). There may also be a difference in mortality as great as 20%, but this was shown to be statistically significant only when three studies (25,46,54) which had failed specific inclusion criteria for this meta-analysis were subsequently included.…”

“…In most instances, colonization of the gastrointestinal and respiratory tracts with pathogenic gramnegative bacteria precedes the development of infection in these patients. As an approach to prevent this progression from colonization through infection, the use of topical nonabsorbable antibiotics to selectively decontaminate the digestive tract (SDD) has been evaluated in 14 studies with historic controls (7,18,21,23,31,33,36,37,50,(52)(53)(54)63) and 26 studies with concurrent controls (1, 3, 4, 7, 9, 10, 15, 19, 22, 25, 27, 29, 32, 38, 42, 44-46, 49, 54-56, 58, 63, 65).…”

Mikrobiologische und klinische Wirksamkeit der selektiven Darmdekontamination bei der transthorakalen Resektion von Oesophagus- und Kardiacarcinomen

“…Es bestehen Hinweise für eine Verbesserung klinischer Behandlungsergebnisse durch die Senkung von bronchopulmonalen Infektionen und Harnwegsinfekten, die auch in dieser Studie aufgrund der mikrobiologischen und klinischen Ergebnisse nachvollzogen werden konnten [10]. Jedoch konnten die meisten Studien eine Senkung der Letalität nicht belegen, so dass nach einem gezielten Einsatz der SDD für Patienten gesucht wurde, die in besonderer Weise von dieser Prophylaxe profitieren [4,9].…”

Prevention of hospital-acquired pneumonia in critically ill patients

“…Although in most of the studies patients were randomized to receive prophylaxis or no prophylaxis, a few trials evaluated control and treatment groups in a sequential or alternating fashion (17,23,26,34,35,38). Only 8 of 17 trials were placebo controlled (6,21,23,26,33,34,46,48); the placebo usually consisted of the vehicle for the topical formulation. We examined in Tables 1 and 2 the effect of prophylaxis on the incidence of colonization and infection, the need for antibiotics given therapeutically, and the mortality rate after entry into the study as well as the duration of hospitalization or ICU stay.…”

“…Although most studies evaluated overall mortality, some provided data on deaths directly attributable to nosocomial pneumonia (4,17,25,26,33,58,62). As indicated in Tables 1 and 2, in only one study, that of Ulrich et al (62), was there a statistically significant decrease in mortality in the total group of patients given antibiotics prophylactically.…”