Selective Decontamination of the Digestive Tract in Multiple Trauma Patients

Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients*

“…This overgrowth has been reported in several studies (12)(13)(14)(15). The same situation was observed by our group in the present study, and a higher level of colonization by S. epidermidis was found in SDD than in control patients (9). Other groups did not find any increase in the growth of gram-positive bacteria after the use of SDD (16,17).…”

“…One of the most important factors influencing the emergence of antibioticresistant bacteria is the extensive use of antibiotics, whatever the cause of administration, including the use of SDD (8). In our unit, SDD has been routinely used in multiple-trauma patients but not in the other patients admitted to the unit (9). This is in agreement with the conclusion of two recent meta-analyses (10,11) stating that the survival advantage offered by SDD is greater in surgical and trauma patients, whereas medical patients derive no such benefit.…”

The use of topical nonabsorbable gastrointestinal antifungal prophylaxis to prevent fungal infections in critically ill immunocompetent patients: A meta-analysis

“…1) (14,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). One study applied amphotericin B through the nasogastric tube and nystatin to the oropharyngeal cavity (37), four studies applied nystatin at both locations (38 -41), and 10 studies applied topical amphotericin B to both locations (42)(43)(44)(45)(46)(47)(48)(49)(50)(51). The doses of nystatin and amphotericin B ranged from 1 to 2 million units four times a day and from 300 to 500 mg four times a day, respectively.…”

“…The doses of nystatin and amphotericin B ranged from 1 to 2 million units four times a day and from 300 to 500 mg four times a day, respectively. Ten studies used systemic antibacterials (38, 40, 42-46, 49 -51) and four studies used topical nonabsorbable antibacterials in addition to topical nonabsorbable antifungal prophylaxis (37,41,47,48) in the treatment group but not the placebo group. A single study compared topical nystatin alone with placebo (39).…”

All great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truth

“…Suspected disadvantages of SDD in terms of selective pressure should therefore be compared with those of traditional antimicrobial usage. However, this can be a problem as there tends to be a significant reduction in the prescription of other parenteral antimicrobials in those ICUs adopting SDD [79,80]. Unpredictability and frequent delay in the appearance of resistance is characteristic of all antimicrobial regimens.…”