Selective decontamination of the digestive tract: A measure whose time has passed?

Current Opinion in Infectious Diseases

Volumn 9, Issue 4, 1996, Pages 270-275

  Bonten, Marc J M ^a   Weinstein, Robert A ^b  

^a MAASTRICHT UNIVERSITY MEDICAL CENTER   (Netherlands)

^b RUSH MEDICAL COLLEGE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; SUCRALFATE;

ANTIBIOTIC RESISTANCE; ARTIFICIAL VENTILATION; CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; DOUBLE BLIND PROCEDURE; ENTERIC FEEDING; GASTROINTESTINAL INFECTION; GLOTTIS; HUMAN; META ANALYSIS; MORTALITY; NONHUMAN; PARENTERAL DRUG ADMINISTRATION; PNEUMONIA; RANDOMIZED CONTROLLED TRIAL; REVIEW; STRESS ULCER; SUCTION; SUPINE POSITION; TOPICAL DRUG ADMINISTRATION;

EID: 0029839068     PISSN: 09517375     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001432-199608000-00012     Document Type: Review

References (43)

1. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin • MH, Wolff M, Spencer RC, Hemmer M: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European prevalence of infection in intensive care (EPIC) study. JAMA 1995, 274:639-644. The prevalence of ICU-acquired infections was determined on a single day in 1417 European ICUs with 10038 patients. Twenty per cent of the patients had ICU-acquired infections, most frequently of the respiratory tract.
2. Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF: The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intens Care Med 1984, 10:185-192.
3. Dever LL, Johanson WG Jr : An update on selective decontamination of the digestive tract. Curr Opin Infect Dis 1993, 6: 744-750.
4. Selective Decontamination of the Digestive Tract Trialists' Collaborative Group: Meta-analysis of randomised trials of selective decontamination of the digestive tract. BMJ 1993, 307:525-532
5. Vandenbroucke-Grauls CMJE, Vandenbroucke JP: Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 1991, 338:859-862.
6. Kollef MH: The role of selective digestive tract decontamination on mortality and respiratory tract infections: a meta-analysis. Chest 1994, 105:1101-1108.
7. Heyland DK, Cook DJ, Jaeschke R, Griffith L, Lee HN, Guyatt GH: Selective decontamination of the digestive tract: an overview. Chest 1994, 105:1221-1229.
8. Villar J, Carroli G, Belizán JM: Predictive ability of meta-analyses of randomised controlled trials. Lancet 1995, 345:772-776.
9. Borzak S, Ridker PM: Discordance between meta-analyses and large-scale randomized, controlled trials. Examples from the management of acute myocardial infarction. Ann Intern Med 1995, 123:873-877.
10. Wiener J, Itokazu G, Nathan C, Kabins SA, Weinstein RA: A •• randomized, double-blind, placebo-controlled trial of selective decontamination in a medical-surgical intensive care unit Clin Infect Dis 1995, 20:861-867. A randomized, double-blind study in a medical-surgical ICU comparing 30 patients with SDD to 31 control patients. There was no difference in infections, although a trend towards more frequent infection with gentamicin-resistant enterococci was found in patients with SDD.
11. Ferrer M, Torres A, González J, Puig de la Bellacasa J, El-Ebiary M, Roca M, Gatell JM, Rodriguez-Roisin R: Utility of selective digestive decontamination in mechanically ventilated patients. Ann Intern Med 1994, 120:389-395.
12. Korinek AM, Laisne MJ, Nicolas MH, Raskine L, Deroin V, Sanson-Lepors MJ: Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study. Crit Care Med 1993, 21:1466-1473.
13. Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S: A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992, 326:594-599.
14. Hammond JMJ, Potgieter PD, Saunders GL, Forder AA: Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992, 340:5-9.
15. Kaufhold A, Behrendt W, Kräuss T, van Saene HKF: Selective decontamination of the digestive tract and methiclllin-resistant Staphylococcus aureus [Letter]. Lancet 1992, 339:1411-1412.
16. Bonten MJM, Gaillard CA, van Tiel FH, van der Geest S, Stobberingh EE: Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents. Antimicrob Agents Chemother 1995, 39:2783-2786.
17. Sijpkens YWJ, Buurke EJ, Ulrich C, van Asselt GJ: Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination. Intens Care Med 1995, 21:231-234.
18. Daschner FD: Emergence of resistance during selective decontamination of the digestive tract. Eur J Clin Microbiol Infect Dis 1992, 11:1-3.
19. Hammond JMJ, Potgieter PD: Long-term effects of selective decontamination on antimicrobial resistance. Crit Care Med 1995, 23:637-645.
20. Hurley JC: Prophylaxis with enterai antibiotics in ventilated patients: • selective decontamination or selective cross-infection? Antimicrob Agents Chemother 1995, 39:941-947. To test the assumption that cross-acquisition would be reduced as a consequence of SDD, meta-analyses were done of studies using concurrent and historical controls to analyse observed and expected rates of colonization and infection in control patients. Although some evidence was found for the presence of cross-infection in studies using concurrent controls, the analysis could not determine the direction of cross-infection and this possibility needs to be examined by modern methods of epidemiological typing.
21. Bonten MJM, Gaillard CA, Johanson W G Jr, van Tiel FH, Smeets HGW, van der Geest S, Stobberingh EE: Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 1994, 150:1332-1340.
22. Wilder-Smith CH, Spirig C, Krech T, Merki HS: Bacterial factors in gastric juice. Eur J Gastroenterol Hepatol 1992, 4:885-891.
23. West AP, Abdul S, Sherratt MJ, Inglis TJJ: Antibacterial activity of sucralfate against Escherichia coli, Staphylococcus auereus and Pseudomonas aeruginosa in batch and continuous culture. Eur J Clin Microbiol Infect Dis 1993, 12:869-871.
24. Bergmans D, Bonten M, Gaillard C, van Tiel F, van der Geest S, Stobberingh EE: In vitro antibacterial activity of sucralfate. Eur J Clin Microbiol Infect Dis 1994, 13:615-620.
25. Welage L, Carver P, Welch K: Antibacterial activity of sucralfate versus aluminum chloride in simulated gastric fluid. Eur J Clin Microbiol Infect Dis 1994, 13:1046-1052.
26. Prod'hom G, Leuenberger P, Koerfer J, Blum A, Chiolero R, Schaller MD, Perret C, Spinnler O, Blondel J, Siegrist H et al.: Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer a randomised controlled trial. Ann Intern Med 1994, 120:653-662.
27. Ben-Menachem T, Fogel R, Patel RV, Touchette M, Zarowitz BJ, Hadzijahic N, Divine G, Verter J, Bresalier RS: Prophylaxis for stressrelated gastric hemorrhage in the medical intensive care unit: a randomized, controlled, single-blind study. Ann Intern Med 1994, 121:568-575.
28. Bonten MJM, Gaillard CA, van der Geest S, van Tiel FH, Beysens A, •• Smeets HGW, Stobberingh EE: The role of intragastric acidity and stress ulcer prophylaxis on colonization and infection in mechanicaly ventilated patients. A stratified, randomized, double blind study of sucralfate versus antacids. Am J Respir Crit Care Med 1995, 152:1825-1834. This was a prospective, randomized, double-blind study comparing sucralfate (n=67) with antacids (n=74). Patients were stratified according to initial intragastric pH. No differences were demonstrated between the groups for intragastric acidity (measured with computerized continuous intragastric pH monitoring), colonization of stomach and respiratory tract or incidence of VAP. The diagnosis of VAP was made on quantitative cultures of samples obtained by bronchoscopic techniques.
29. Lee B, Chang RWS, Jacobs S: Intermittent nasogastric feeding: a simple and effective method to reduce pneumonia among ventilated ICU patients. Clin Intens Care 1990, 1:100-102.
30. Montecalvo MA, Steger KA, Farber HW, Smith BF, Dennis RC, Fitzpatrick GF, Pollack SD, Korsberg TZ, Birkett DH, Hirsch EF: Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal feedings. Crit Care Med 1992, 20:1377-1387.
31. Heyland D, Bradley C, Mandell LA: Effect of acidified enteral feedings on gastric colonization in the critically ill patients. Crit Care Med 1992, 20:1388-1394.
32. Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A, Lomen̄a F, Rodriguez-Roisin R: Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992, 116:540-543.
33. Orozo-Levi M, Torres A, Ferrer M, Piera C, El-Ebiary M, Puig de la • Bellacasa J, Rodriguez-Roisin R: Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 1995, 152:1387-1390. In a randomized, two-period cross-over trial, 15 patients had higher endobronchial radioactive counts when treated in the supine position than when treated in the semirecumbent position, but no differences in radioactive counts were found in the oropharynx. A sequence of colonization from the stomach to the trachea was not demonstrated in any patient. The effect on pneumonia was not studied.
34. Gentilello L, Thompson DA, Tonnesen AS, Hemandez D, Kapadia AS, Allen SJ, Houtchens BA, Miner ME: Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 1988, 16:783-786.
35. Summer WR, Curry P, Haponik EF, Nelson S, Elston R: Continuous mechanical turning of intensive care patients shortens length of stay in some diagnostic-related groups. J Crit Care 1989, 4:45-53.
36. Kelley RE, Vibulresth S, Bell L, Duncan RC: Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke. Stroke 1987, 18:638-642.
37. Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM: The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. Chest 1990, 97:132-137.
38. Mahul P, Auboyer C, Jospe R, Ros A, Guerin C, El Khouri Z, Galliez M, Dumont A, Gaudin O: Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer propylaxis. Intens Care Med 1992, 18:20-25.
39. Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, •• Fernandez R, Baigorri F, Mestre J: Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995, 122:179-186. In a prospective randomized study, continous subglottic suctioning (n=76) was associated with a lower incidence of VAP (18%), compared with the incidence (33%) among control patients (n=77). The difference was caused by a reduction in the incidence during the first week of ventilation. Diagnosis of VAP was made on quantitative cultures of samples obtained by bronchoscopic techniques.
40. du Moulin GC, Paterson DG, Hedley-Whyte J, Lisbon A: Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1982, i:242-245.
41. Torres A, El-Ebiary M, González J, Ferrer M, Puig de la Bellacasa J, Gené A, Martos A, Rodriguez-Roisin R: Gastric and pharyngeal flora in nosocomial pneumonia acquired during mechanical ventilation. Am Rev Respir Dis 1993, 148:352-357.
42. Bonten MJM, Gaillard CA, van Tiel FH, Smeets HGW, van der Geest S, Stobberingh EE: The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest 1994, 105:878-884.
43. de Latorre FJ, Pont T, Ferrer A, Rossello J, Palomar M, Planas M: Pattern of tracheal colonization during mechanical ventilation. Am J Respir Crit Care Med 1995, 152:1028-1033.