Chest
Selective Digestive Decontamination Should Not Be Routinely Employed*
Section snippets
Prevalence of Antimicrobial Resistance in the ICU
ICUs, along with other specialty areas within hospitals (eg, organ transplant wards, oncology units), frequently have high levels of antimicrobial usage among patients maintained in close proximity. This type of environment may explain the high levels of antimicrobial resistance observed within such areas of the hospital. A multicenter European survey examined a total of 9,166 Gram-negative bacterial strains from 7,308 patients in ICUs from 118 hospitals.5 The most frequently isolated organisms
Risk Factors for Antibiotic Resistance
A number of investigators have demonstrated a close association between the use of antibiotics and the emergence of antibiotic resistance both in Gram-negative and Gram-positive bacteria.7891011 The recent experience with antibiotic cycling or scheduled antibiotic class changes also demonstrates how rapidly antibiotic-resistant bacteria can emerge within the hospital setting as antibiotic use patterns change.121314 Trouillet and coworkers15 examined 135 consecutive episodes of VAP, of which 77
Implications of Increasing Bacterial Antibiotic Resistance
In general, infections with antibiotic-resistant bacteria are associated with greater hospital mortality and longer lengths of hospital stay.22 Colonization and infection with antibiotic-resistant bacteria increase the likelihood that patients will receive inadequate antimicrobial therapy (ie, antimicrobial therapy to which the identified causative microorganisms are resistant). Several investigations have demonstrated a strong association between the administration of inadequate antibiotic
Recent Meta-analyses of SDD
The main focus of SDD is to selectively eliminate aerobic Gram-negative bacilli and yeast from the aerodigestive tract using a combination of topical and parenteral antibiotics (Table 1). A large number of clinical trials have examined the use of SDD in the ICU setting. Meta-analysis represents a method used to group randomized clinical trials in order to increase the power of their observations. Two large meta-analyses have been conducted that review the use of SDD. The first is a European
SDD and Antibiotic Resistance
In one of the largest trials of SDD, Gastinne and coworkers46 found that pneumonia due to staphylococci was more common among SDD-treated patients. The emergence of pneumonia due to Gram-positive bacteria in association with the use of SDD has also been reported by other investigators.47 Hammond and Potgieter48 found a statistically significant increase in the occurrence rate of infections caused by Acinetobacter species in the year after beginning a trial of SDD in their ICUs compared to the
Conclusion
Antibiotic resistance has become a major concern for both community-acquired and nosocomial infections. The development and use of SDD has occurred during the recent explosion in infections due to antibiotic-resistant microorganisms. Unfortunately, the overall impact of SDD on the development of antibiotic resistance cannot be fully determined based on the existing medical literature. However, the use of SDD as well as other antibiotics should be carefully monitored as a potential stimulus for
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The Use of Prebiotics, Probiotics, and Synbiotics in the Critically Ill
2016, Probiotics, Prebiotics, and Synbiotics: Bioactive Foods in Health PromotionRespiratory care
2007, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :Although selective decontamination of the digestive track has been shown to be beneficial in surgical patients in general 77–79 and particularly in patients with head trauma80, this treatment is controversial. It potentially poses a detrimental effect on the developing of antibiotic-resistant nosocomial flora, which has not been adequately studied.81 The following preventive methods have been recommended to avoid chronic aspiration of oropharyngeal secretions: semi-recumbent positioning (30 degrees reverse Trendelenburg), restriction of antibiotic usage, continuous or intermittent aspiration of oropharyngeal secretions82, subglottic drainage83, avoidance of reintubation84–86, avoidance of gastric overdistension, and oversedation.
The Appropriate Use of Antibiotics in Surgery: A Review of Surgical Infections
2007, Current Problems in SurgeryCitation Excerpt :However, most studies were conducted in units with low levels of antibiotic-resistant pathogens. Because of this concern, this practice has yet to gain acceptance in the United States and is not recommended by the ATS for routine use.110 The use of short-duration parenteral prophylactic antibiotics may be useful in some patient populations.111
Selective digestive decontamination. Why don't we apply the evidence in the clinical practice?
2007, Medicina IntensivaSelective decontamination of the digestive tract: What outcomes matter?
2010, Critical Care MedicinePrevention of ventilator-associated pneumonia: Do not forget to disinfect the mouth
2007, Critical Care Medicine