Role of selective decontamination in surgery

Abstract

Aspects of selective decontamination as an antibiotic prophylaxis in general surgery are discussed with respect to the respiratory tract and wound infection. The high rate of nosocomial infection encountered in surgical patients, who experience up to 71 per cent of all such infection, is considered. The infection rate increases to 70-80 per cent after 1 week in the surgical intensive care unit, while the infection-related mortality rate rises to up to 60 per cent. The endogenous origin of nosocomial infection suggests the importance of maintaining colonization resistance to prevent colonization with Gram-negative micro-organisms, especially using selective decontamination which eliminates potentially pathogenic micro-organisms while leaving colonization resistance intact. Selective decontamination has proved effective in decreasing infection rates by 50-80 per cent, and is especially successful in respiratory tract infection. Possible adverse effects and future indications for selective decontamination are discussed.

Perioperative Selective Decontamination of the Digestive Tract (SDD) in Elective Colorectal Surgery

“…These nosocomial infections usually occur after 48 h of admission and are mostly caused by aerobe Gram-negative microorganisms. 4,5 These Gram negatives generally originate from the patient's digestive tract. Colonization of the digestive tract with potentially pathogenic microorganisms (PPMs) can harm the patient in two different ways.…”

Selective decontamination of the colon before elective colorectal surgery

“…By eliminating or severely reducing the aerobic flora of the bowel lumen the synergy between aerobic and anaerobic bacteria is disturbed and abscess formation reduced. We have not assessed the incidence of postoperative chest infection in this study, but there is evidence that preoperative selective decontamination may also reduce the incidence of this complication [16].…”

“…A combination of antibiotic and antifungal medication is given as a paste to the mouth and orally to eliminate the fungal and aerobic bacterial contamination of the GIT. This regimen has been shown to reduce the incidence of nosocomial infections but not to reduce the mortality in these seriously ill patients [16,28].…”

“…We have shown that a rapid reduction of the viable count of these organisms can be achieved by 24-hour preparation of the bowel using two doses of a cathartic, such as sodium picosulfate (Picolax) accompanied by ciprofloxacin 500 mg [15]. Such antibiotic bowel preparation has the advantage of preserving the predominant anaerobic flora, which may influence colonization resistance [16,17], yet disturbs the synergy known to No. remaining for 159 168 evaluation exist between aerobic and anaerobic bacteria in the formation of wound abscesses [18,19]--the principle of selective decontamination.…”

Future directions in the management of tertiary peritonitis

“…Another option would be to eliminate all potentially pathogenic gram-negative bacteria and fungi in the digestive tract by selective decontamination (SD) [35,36]. Luiten et al showed a reduced mortality in patients with necrotizing pancreatitis when infection of the pancreatic tissue was prevented by SD [37].…”