Selective decontamination of the digestive tract to prevent postoperative infection: A randomized placebo-controlled trial in liver transplant patients

Zwaveling, JH; Maring, John K.; Klompmaker, I. J.; Haagsma, Elizabeth B.; Bottema, Jan T.; Laseur, M.; Winter, Heinrich L J; Enckevort, Petra J. van; TenVergert, Elisabeth M.; Metselaar, Herold J.; Bruining, H. A.; Slooff, Maarten J. H.

doi:10.1097/00003246-200206000-00004

Cited by 77 publications

(51 citation statements)

References 21 publications

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“…Although 1 study suggested that SID could reduce the relative incidence of infections by enteric bacteria in comparison with a historical cohort, 16 no effect on the global incidence of infection or the mortality could be demonstrated in a randomized study. 17 It is important to note that in this last study, fluoroquinolones were administered not after transplantation but while patients were on the waiting list. Although FQ-SID appeared to reduce the incidence of infections due to enteric bacteria in LTRs, this effect was not evident after adjustments by other variables, including the transplant center.…”

Section: Discussionmentioning

confidence: 95%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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The role of selective intestinal decontamination with fluoroquinolones (FQ-SID) in the prevention of early bacterial infections (EBIs) in liver transplant recipients (LTRs) is unknown. We used the online database of the Spanish Network of Infection in Transplantation/ Spanish Network for Research in Infectious Diseases, which prospectively analyzed 1010 LTRs from 12 Spanish hospitals from September 2003 to February 2005. We compared the incidence and etiology of EBIs (30 days after transplantation) in 415 LTRs from 4 centers that used FQ-SID (>7 days) and in 595 LTRs from 8 hospitals that did not use FQ-SID. A multivariate logistic regression analysis (including an adjustment for the transplant center factor) was performed to evaluate the potential protective factor of FQ-SID in the development of EBIs. We reported 266 EBI episodes in 252 LTRs (incidence ¼ 24.9%). There were no differences in the incidence of EBIs between patients in the FQ-SID group and patients not in the FQ-SID group [109/415 (26.3%) versus 143/595 (24%), P ¼ 0.9]. Although LTRs who received FQ-SID had a lower incidence of infections due to enteric bacteria (2.7% versus 6.5%, P ¼ 0.007) and a higher incidence of infections due to nonfermenting gram-negative bacilli (6.6% versus 2.6%, P ¼ 0.004), these findings could not be confirmed after an adjustment by the center factor in the multivariate models. We found no significant differences in the incidence of enterococcal infections (3.4% with FQ-SID versus 3.9% without FQ-SID, P ¼ 0.5). Multivariate analysis did not confirm any protective effect of FQ-SID against the development of EBIs by enteric bacteria. In conclusion, FQ-SID does not reduce the incidence of EBIs in LTRs and could be withheld from this group of patients. Liver Transpl 17:896-904,

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Section: Discussionmentioning

confidence: 95%

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

et al. 2011

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“…Most studies showed that SBD was indeed able to reduce bacterial colonization of the gut, but had no impact on overall infection rates or mortality. The spectrum of isolated bacteria under SBD changed from Gram-negative to Gram-positive bacteria, especially Enterococci [23,24].…”

Section: Preventionmentioning

confidence: 99%

Prebiotics, probiotics, synbiotics in surgery—are they only trendy, truly effective or even dangerous?

Rayes

Seehofer

Neuhaus

2008

Langenbecks Arch Surg

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“…Patients undergoing liver transplant are very vulnerable to infection during the early post-operative period, particularly with gram-negative organisms. SDD has been studied in these patients in several RCTs [111][112][113] and meta-analyses [114]. The results have been conflicting and several small RCTs failed to show any benefit of SDD over standard care following liver transplant.…”

Section: Evidence Supporting Use In Surgical Patientsmentioning

confidence: 99%

Sepsis, the Liver and the Gut

Azzopardi¹,

Fenech²,

Piscopo³

2012

Sepsis - An Ongoing and Significant Challenge

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Selective decontamination of the digestive tract to prevent postoperative infection: A randomized placebo-controlled trial in liver transplant patients

Cited by 77 publications

References 21 publications

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

Selective intestinal decontamination with fluoroquinolones for the prevention of early bacterial infections after liver transplantation

Prebiotics, probiotics, synbiotics in surgery—are they only trendy, truly effective or even dangerous?

Sepsis, the Liver and the Gut

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