Selective decontamination of the digestive tract: all questions answered?

Although many studies have shown beneficial effects of SDD on the incidence of respiratory tract infections, SDD did not become routine practice because mortality reduction was not demonstrated in individual trials, beneficial effects on duration of ventilation, ICU stay or hospital stay were not de...

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Bibliographic Details
Published in:Critical care (London, England) England), 2003-06, Vol.7 (3), p.203-205
Main Authors: Bonten, Marc J M, Joore, Hans C A, de Jongh, Bartelt M, Kluytmans, Jan, Kuijper, Ed J, van Leeuwen, Henk J, de Smet, Anne Marie G A, Vandenbroucke-Grauls, Christina
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Critical Care - methods
Cross Infection - prevention & control
Decontamination - methods
Digestive System - microbiology
Drug Resistance, Bacterial
Humans
Infection Control - methods
Outcome Assessment (Health Care) - methods
Research Design
Survival Analysis
Treatment Outcome
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Summary:Although many studies have shown beneficial effects of SDD on the incidence of respiratory tract infections, SDD did not become routine practice because mortality reduction was not demonstrated in individual trials, beneficial effects on duration of ventilation, ICU stay or hospital stay were not demonstrated, cost-efficacy had not been demonstrated, and selection of antibiotic resistance was considered a serious side-effect. A recent study has now shown improved patient survival and lower prevalence of antibiotic resistance in patients receiving SDD. Why could this study show mortality reduction, where all others studies had failed before? And do the microbiological data unequivocally prove protective effects of SDD on emergence of antibiotic resistance? Interestingly, the reported mortality reductions exceeds even the most optimistic predictions from previous meta-analyses, but a clear explanation is not yet evident. The data on antibiotic resistance, however, are rather superficial and do not allow to interpret the underlying epidemiological dynamics. Therefore, the recent findings are provocative and shed new light on the SDD issue, warranting studies confirming its beneficial effects but also addressing several important aspects related to study design.
ISSN:1364-8535
1466-609X
DOI:10.1186/cc1881