Selective digestive tract decontamination in intensive care medicine. Fundamentals and current evaluation;Selektive darm-dekontamination in der intensivmedizin: Grundlagen und aktuelle bewertung

Anaesthesist

Volumn 52, Issue 2, 2003, Pages 142-152

  Krueger, W A ^a   Heininger, A ^b   Unertl, K E ^b  

^a UNIVERSITY HOSPITAL TÜBINGEN   (Germany)

^b NONE

Author keywords

Antibiotic prophylaxis; Antibiotic resistance; Infection prevention; Nosocomial infection mortality; Review; SDD; Selective digestive tract decontamination; Ventilator associated pneumonia

Indexed keywords

AMPHOTERICIN B; ANTIBIOTIC AGENT; CEFOTAXIME; CEFTAZIDIME; CIPROFLOXACIN; COLISTIN; GENTAMICIN; NORFLOXACIN; NYSTATIN; OFLOXACIN; POLYMYXIN B; TOBRAMYCIN; VANCOMYCIN; ANTIINFECTIVE AGENT;

ACUTE HEMORRHAGIC PANCREATITIS; ANTIBIOTIC PROPHYLAXIS; ANTIBIOTIC RESISTANCE; ARTICLE; ARTIFICIAL VENTILATION; CLINICAL TRIAL; DIAGNOSTIC ERROR; DISEASE SEVERITY; GRAM POSITIVE BACTERIUM; HOSPITAL INFECTION; HUMAN; INFECTION PREVENTION; INTENSIVE CARE UNIT; LIVER TRANSPLANTATION; META ANALYSIS; MORTALITY; MOUTH FLORA; MULTIDRUG RESISTANCE; OROPHARYNX; PATIENT SELECTION; PNEUMONIA; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; SELECTIVE DIGESTIVE TRACT DECONTAMINATION; STOMACH; SURVIVAL RATE; TECHNIQUE; DIGESTIVE SYSTEM; INTENSIVE CARE; LOBAR PNEUMONIA; METHODOLOGY; MICROBIOLOGY; REVIEW; VENTILATOR;

ANTI-BACTERIAL AGENTS; DIGESTIVE SYSTEM; HUMANS; INTENSIVE CARE; OROPHARYNX; PNEUMONIA, PNEUMOCOCCAL; STOMACH; VENTILATORS, MECHANICAL;

EID: 0037296623     PISSN: 00032417     EISSN: None     Source Type: Journal    
DOI: 10.1007/s00101-002-0443-1     Document Type: Article

References (87)

1. Abele-Horn M, Dauber A, Bauernfeind A, Russwurm W, Seyfarth-Metzger I, Gleich P, Ruckdeschel G (1997) Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Med 23:187-195
2. Barret JP, Jeschke MG, Herndon DN (2001) Selective decontamination of the digestive tract in severely burned pediatric patients. Burns 27:439-445
3. Bergmans DCJJ, Bonten MJM, Galliard CA et al. (2001) Prevention of ventilator-associated pneumonia by oral decontamination. Am J Respir Crit Care Med 164:382-388
4. Bonten MJM, Weinstein RA (1999) Bird's eye view of nosocomial infections in medical ICU: blue bugs, fungi, and device-days. Crit Care Med 27:853-854
5. Bonten MJM,Gaillard CA, Leeuw PW de, Stobberingh EE (1997) Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis 24:309-319
6. Bregeon F, Ciais V, Carret V et al. (2001) Is ventilator-associated pneumonia an independent risk factor for death? Anesthesiology 94:554-560
7. Brun-Buisson C, Legrand P, Rauss A et al. (1989) Intestinal decontamination for control of nosocomial multiresistant Gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med 110:873-881
8. Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV (1986) Multiple-organ-failure syndrome. Arch Surg 121:196-208
9. Cirera I, Bauer TM, Navasa M et al. (2001) Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 34:32-37
10. Craven DE, Connolly MG, Lichtenberg DA, Primeau PJ, McCabe WR (1982) Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. New Engl J Med 306:1505-1509
11. Dahms R, Carlson M, Lohr B, Beilman G (2000) Selective digestive tract decontamination and vancomycin-resistant enterococcus isolation in the surgical intensive care unit. Shock 14:343-346
12. D'Amico R, Pifferi S, Leonetti C,Torri V, Tinazzi A, Liberati A (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: a systematic review of randomised controlled trials. BMJ 316:1275-1285
13. Dietzel W (1978) Probleme der Sterilität in der Inhalations- und Beatmungs-Inhalations-therapie. Hyg Med 3:114-118
14. Ebner W, Kropec-Hübner A, Daschner FD (2000) Bacterial resistance and overgrowth due to selective decontamination of the digestive tract. Eur J Clin Microbiol Infect Dis 19:243-247
15. Emre S, Sebastian A, Chodoff L et al. (1999) Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant. Mt Sinai J Med 66:310-313
16. Enckevort PJ van, Zwaveling JH, Bottema JT, Maring JK, Klompmaker IJ, Slooff MJ, Ten Vergert EM (2001) Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients. Pharmacoeconomics 19:523-530
17. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281-288
18. Fagon JY, Chastre J, Vuagnat A,Trouillet JL, Novara A, Gibert C (1996) Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 275:866-869
19. Fink JB, Krause SA, Barrett L, Schaaff D, Alex CG (1998) Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia. Chest 113:405-411
20. Fridkin SK (2001) Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 29 [Suppl]:N64-N68
21. Gastinne H, Wolff M, Lachatre G, Boiteau R, Savy F-P (1991) Antibiotic levels in bronchial tree and serum during selective digestive decontamination. Intensive Care Med 17:215-218
22. Gastinne H,Wolff M, Delatour F, Faurisson F, Chevret S (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. New Engl J Med 326:594-599
23. González C, Rubio M, Romero-Vivas J, González G, Picazo JJ (1999) Bacteremic pneumonia due to Staphylococcus aureus: A comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 29:1171-1177
24. Hess D, Burns E, Romagnoli D, Kacmarek RM (1995) Weekly ventilator circuit changes. A strategy to reduce costs without affecting pneumonia rates. Anesthesiology 82:903-911
25. Hjortrup A, Rasmussen A, Hansen BA, Hoiby N, Heslet L, Moesgaard F, Kirkegaard P (1997) Early bacterial and fungal infections in liver transplantation after oral selective bowel decontamination. Transplant Proc 29:3106-3110
26. Ibrahim EH, Ward S, Sherman G, Kollef MH (2000) A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest 117:1434-1442
27. Johanson WG, Pierce AK, Sanford JP (1969) Changing pharyngeal bacterial flora of hospitalized patients. Emergence of Gram-negative bacilli. New Engl J Med 281:1137-1140
28. Johanson WG, Pierce AK, Sanford JP, Thomas GD (1972) Nosocomial respiratory infections with Gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 77:701-706
29. Jonge E de, Schultz MJ, Spanjaard L, Bossuyt PPM, Vroom MB, Dankert J, Kesecioglu J (2002) Effects of selective decontamination of the digestive tract on mortality and antibiotic resistance, Abstract 30. Intensive Care Med 28 [Suppl 1]:S12
30. Joshi N, Localio AR, Hamory BH (1992) A predictive risk index for nosocomial pneumonia in the intensive care unit. New Engl J Med 93:135-142
31. Kawakami J, Matsuse T, Kotaki H et al. (1994) The effect of food on the interaction of ofloxacin with sucralfate in healthy volunteers. EurJ Clin Pharmacol 47:67-69
32. Kollef MH (1999) The prevention of ventilator-associated pneumonia. New Engl J Med 340:627-634
33. Kollef MH, Shapiro SD, Fraser VJ et al. (1995) Mechanical ventilation with or without 7-day circuit changes. Ann Intern Med 123:168-174
34. Krueger WA, Unertl K (1997) Verhalten bei Methicillin-resistentem Staphylococcus aureus (MRSA). In: Deutsche Akademie for Anästhesiologische Fortbildung (Hrsg) Refresher course - aktuelles Wissen for den Anasthesisten 23. Springer, Berlin Heidelberg New York, S121-127
35. Krueger WA, Unertl KE (2000) Die geschichtliche Entwicklung der Intensivmedizin in Deutschland. Zeitgenössische Betrachtungen. Anaesthesist 49:743-751
36. Krueger WA, Unertl KE (2000) Epidemiologie grampositiver Infektionen auf Intensivstationen - Ergebnisse der EPIC-Studie. Chemother J 9 [Suppl 19]:2-4
37. Krueger WA, Unertl KE (2002) Neue Therapie-option für Intensivpatienten mit Infektionen durch grampositive Bakterien - Überblick über Linezolid. Anasthesiol Intensivther Noffallmedizin Schmerzther 37:199-204
38. Krueger WA, Unertl KE (2002) Selective decontamination of the digestive tract: current status. Curr Opin Crit Care 8:139-144
39. Krueger WA, Ruckdeschel G, Unertl K (1997) Influence of intravenously administered ciprofloxacin on aerobic intestinal microflora and fecal drug levels when administered simultaneously with sucralfate. Antimicrob Agents Chemother 41:1725-1730
40. Krueger WA, Ruckdeschel G, Unertl K (1999) Elimination of fecal Enterobacteriaceae by intravenous ciprofloxacin is not inhibited by concomitant sucralfate - a microbiological and pharmacokinetic study in patients. Infection 27:335-340
41. Krueger WA, Lenhart F-P, Neeser G et al. (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients. A prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166:1029-1037
42. Kuo PC, Bartlett ST, Lim JW, Plotkin JS, Wilson S, Johnson LB (1997) Selective bowel decontamination in hospitalized patients awaiting liver transplantation. Am J Surg 174:745-749
43. Laggner AN, Tryba M, Georgopoulos A et al. (1994) Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate? Wien Kiln Wochenschr 106:15-19
44. LeBel M (1988) Ciprofloxacin: chemistry, mechanism of action, resistance, antimicrobial spectrum, pharmacokinetics, clinical trials, and adverse reactions. Pharmacotherapy 8:3-33
45. Lehto P, Kivistö KT (1994) Effect of sucralfate on absorption of norfloxacin and ofloxacin. Antimicrob Agents Chemother 38:248-251
46. Lingnau W, Berger J, Javorsky J, Fille M, Allerberger F, Benzer H (1998) Changing bacterial ecology during a five year period of selective intestinal decontamination. J Hosp Infect 39:195-206
47. Llovet JM, Rodríguez-Iglesias P, Moitinho E et al. (1997) Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. J Hepatol 26:88-95
48. Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1995) Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 222:57-65
49. Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1997) Differential prognosis of gram-negative vs. gram-positive infected and sterile pancreatic necrosis: results of a randomized trial in patients with severe acute pancreatitis treated with adjuvant selective decontamination. Clin Infect Dis 25:811-816
50. Luiten EJT, Hop WCJ, Endtz HP, Bruining HA (1998) Prognostic importance of gram-negative intestinal colonization preceding pancreatic infection in severe acute pancreatitis. Intensive Care Med 24:438-445
51. Marshall JC, Christou NV, Horn R, Meakins JL (1988) The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg 123:309-315
52. McGowan Jr JE (2001) Increasing threat of gram-positive bacterial infections in the intensive care unit setting. Crit Care Med 29 [Suppl]:N69-N74
53. Morar P, Makura Z, Jones A, Baines P, Selby A, Hughes J, Saene R van (2000) Topical antibiotics on tracheostoma prevents exogenous colonization and infection of lower airways in children. Chest 117:513-518
54. Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients. Arch Surg 134:170-176
55. Niederman MS, Craven DE (1996) Devising strategies for preventing nosocomial pneumonia - should we ignore the stomach? Clin Infect Dis 24:320-323
56. Nieuwenhoven CA van, Buskens E, Tiel FH van, Bonten MJM (2001) Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients. JAMA 286:335-340
57. Nieuwenhoven CA van,Thiel FH van, Buskens E, Bonten MJM (2001) Influence of methodological quality on study conclusions, letter. JAMA 286:2S47
58. Patel R, Badley AD, Larson-Keller J et al. (1996) Relevance and risk factors of enterococcal bacteremia following liver transplantation. Transplantation 61:1192-1197
59. Patel R, Allen SL, Manahan JM et al. (2001) Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transpl 7:27-31
60. Pierce AK, Sanford JP, Thomas GD, Leonard JS (1970) Long-term evaluation of decontamination of inhalation-therapy equipment and the occurrence of necrotizing pneumonia. New Engl J Med 282:528-531
61. Pittet D, Thiévent B, Wenzel RP, Li N, Auckenthaler R, Suter P (1996) Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 153:684-693
62. Pugin J, Auckenthaler R, Lew DP, Suter PM (1991) Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA 265:2704-2710
63. Ramon J, Dautrey S, Farinoti R, Carbon C, Rubinstein E (1994) Intestinal elimination of ciprofloxacin in rabbits. Antimicrob Agents Chemother 38:757-760
64. Rello J, Rué M, Jubert P, Muses G, Sonora R, Vallés J, Niederman MS (1997) Survival in patients with nosocomial pneumonia: impact of the severity of illness and the etiologic agent. Crit Care Med 25:1862-1867
65. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27:887-892
66. Rodriguez-Roldán JM, Altuna-Cuesta A, López A, Carrillo A, Garcia J, León J, Martínez-Pellús AJ (1990) Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med 18:1239-1242
67. Rohwedder RW, Bergan T, Thorsteinsson SB, Scholl H (1990) Transintestinal elimination of ciprofloxacin. Diagn Microbiol Infect Dis 13:127-133
68. Ruza F, Alvarado F, Herruzo R, Delgado MA, García S, Dorao P, Goded J (1998) Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. Eur J Epidemiol 14:719-727
69. Saene JJM van, Saene HKF van, Stoutenbeek CR Lerk CF (1985) Influence of faeces on the activity of antimicrobial agents used for decontamination of the alimentary canal. Scand J Infect Dis 17:295-300
70. Saene JJM van, Saene HKF van, Lerk CF (1986) Inactivation of quinolones by feces, letter. J Infect Dis 153:999-1000
71. Sánchez García M (2001) Influence of methodological quality on study conclusions, letter. JAMA 286:2545-2546
72. Sánchez García M, Cambronero Galache JA, López Diaz J et al. (1998) Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. Am J Respir Crit Care Med 158:908-916
73. Selden R, Le S, Wang WLL, Bennet JV, Eickhoff TC (1971) Nosocomial Klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 74:657-664
74. Silvestri L, Mannucci F, Saene HKF van (2000) Selective decontamination of the digestive tract: a life saver. J Hosp Infect 45:185-190
75. Sirvent JM, Torres A, El-Ebiary M, Castro P, Batlle J de, Bonet A (1997) Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 155:1729-1734
76. Stoutenbeek CP, Saene HKF van, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10:185-192
77. Stoutenbeek CP, Saene HKF van, Miranda DR, Zandstra DF, Langrehr D (1987) The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357-364
78. Sun X, Wagner DP, Knaus WA (1996) Does selective decontamination of the digestive tract reduce mortality for severely ill patients? Crit Care Med 24:753-75S
79. Unertl K, Ruckdeschel G, Selbmann HK, Forst H, Lenhart FP, Peter K (1987) Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 13:106-113
80. Verwaest C, Verhaegen J, Ferdinande P, Schetz M, Berghe G van den,Verbist L, Lauwers P (1997) Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit. Crit Care Med 25:63-71
81. Vincent JL (2002) The randomized controlled trial turns pro. Intensive Care Med 28:1200-1202
82. Vincent JL, Bihari DJ, Suter PM et al. (1995) The prevalence of nosocomial infection in intensive care units in Europe. JAMA 274:639-644
83. Waaij D van der (1982) Colonization resistance of the digestive tract: clinical consequences and implications. J Antimicrob Chemother 10:263-270
84. Webb CH (2000) Selective decontamination of the digestive tract, SDD: a commentary. J Hosp Infect 46:106-109
85. Young PJ, Ridley SA, Downward G (1998) Evaluation of a new design of tracheal tube cuff to prevent leakage of fluid to the lungs. Br J Anaesth 80:795-799
86. Zandstra DF, Saene HKF van (2001) Selective decontamination of the digestive as infection prevention in the critically ill. Does it lead to resistance? Minerva Anestesiol 67:292-297
87. Zwaweling JH, Maring JK, Klompmaker J et al. (2002) Selective decontamination of the digestive tract to prevent postoperative infection: a randomized placebo-controlled trial in liver transplant patients. Crit Care Med 30:1204-1209