The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: A systematic review and meta-analysis

Abstract

Selective digestive decontamination (SDD) refers to the use of antimicrobials to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract to prevent infections caused by these organisms. Liver transplant patients are highly vulnerable to bacterial infection particularly with gram-negative organisms within the first month after transplantation, and SDD has been proposed as a potential measure to prevent these infections. However, the benefit of this procedure remains controversial. We undertook a systematic review and meta-analysis to determine whether SDD is beneficial in reducing infections overall and those caused by gramnegative bacteria in patients following liver transplantation. All studies that evaluated the efficacy of SDD in liver transplant patients were included. Randomized trials that included liver transplant patients given SDD versus either placebo or no treatment or minimal treatment (e.g., oral nystatin alone), and that provided adequate data to calculate a relative risk ratio, were included in the meta-analysis. Our review shows that most studies found SDD to be effective in reducing gram-negative infection. The nonrandomized and uncontrolled trials also showed benefit with SDD in reducing overall infection; however, the effect on overall infection was limited in the 4 randomized trials, in which the pooled relative risk was 0.88 (95% CI, 0.7-1.1), indicating no statistically significant reduction in infection with the use of SDD. The summary risk ratio for the association between SDD and gram-negative infection was 0.16 (95% CI, 0.07-0.37), indicating an 84% relative risk reduction in the incidence of infection caused by gram-negative bacteria in patients receiving SDD in randomized trials. In conclusion, the available literature supports a beneficial effect of SDD on gram-negative infection following liver transplantation; however, the risk of antimicrobial resistance must be considered. Larger multicenter randomized trials in this patient population to assess the effect of SDD in reducing infection and mortality, while assessing the risk of antimicrobial resistance, are needed. (Liver Transpl 2004;10:817-827.)

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

“…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. A meta-analysis by Safdar et al 18 evaluating different SID modalities in LTRs showed a protective effect of SID against infections by enteric bacteria, but this did not translate into an overall reduction of the rate of EBIs because patients receiving SID had an increased incidence of enterococcal infections. We did not observe differences in the relative incidence of enterococcal infections with respect to the use of FQ-SID, but we did find a higher relative incidence of infections by NFGNBs in patients undergoing FQ-SID, which probably overrode the protective effect against infections due to enteric bacteria.…”

Selective digestive decontamination is superior to oropharyngeal chlorhexidine in preventing pneumonia and reducing mortality in critically ill patients

“…, Sadfar et al (10) and Silvestri et al (16) showed an impact on mortality. However, due to small sample size, the differences were not significant.…”

Bakteriális infekciók májátültetés után

“…Komplex antimikrobiális kezelés, amely az emésztőrendszerben található Gram-negatív baktériumok elleni prevenciót jelenti [11].…”