Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review)

Abstract

Infectious complications are the most common cause of death in patients with severe burns. To date, there is no generally accepted method for preventing such complications in burn injury. One of the possible prevention options is selective intestinal decontamination (SID). This method is based on the enteral administration of non-absorbable antimicrobial agents. The preventive effect of SID involves inhibition of intestinal microflora translocation through the mucous membranes, inasmuch as studies demonstrate that endogenous opportunistic microorganisms are a common cause of infectious complications in various critical conditions. The SID method was originally developed in the Netherlands for patients suffering from mechanical injury. Antimicrobial drugs were selected based on their high activity in relation to the main endogenous opportunistic pathogens and minimal activity against normal intestinal microflora components. The combination of polymyxin (B or E), tobramycin, and amphotericin B with intravenous cefotaxime was chosen as the first SID regimen. Other regimens were proposed afterwards, and the application field of the method was expanded. In particular, it became the method of choice for prevention of infectious complications in patients with severe burn injury. Clinical studies demonstrate efficacy of some SID regimens for preventing infectious complications in patients with thermal injury. Concomitant administration of SID and systemic preventive antibiotics and addition of oropharyngeal decontamination increases the method efficacy. SID is generally well-tolerated, but some studies show an increased risk of diarrhea with this preventive option. In addition, SID increases the risk of developing antibiotic resistance like any other antibiotic regimens.

The Role of Gut Microbiota in the Clinical Outcome of Septic Patients: State of the Art and Future Perspectives

“…Currently, some available therapeutic strategies are aimed at modulating the composition of the intestinal microbiota during infections or as prophylactic therapy in critically ill patients and in patients prone to recurrent infections. Selective intestinal decontamination (SID) is a prophylactic strategy that consists of the administration of non-absorbable topical antimicrobial agents (that preserve anaerobic microbiota) from the oropharynx and upper gastrointestinal tract, without or in association with a short-term course of intravenous broad-spectrum antibiotics, in order to reduce or prevent the incidence of endogenous infection [72,73]. Another strategy often used is the oral administration of beneficial bacteria or factors that positively influence the intestinal microbiota.…”