Cited by 111Nosocomial Infections in ICUSepsis Diagnosis and TreatmentClinical Nutrition and Gastroenterology

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Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth

Silvestri, Luciano, de la Cal, Miguel A., van Saene, Hendrick K. F.·2012·Intensive Care Medicine

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Abstract

Purpose Gut overgrowth is the pathophysiological event in the critically ill requiring intensive care. In relation to the risk of developing a clinically important outcome, gut overgrowth is defined as ≥10(5) potential pathogens including 'abnormal' aerobic Gram-negative bacilli (AGNB), 'normal' bacteria and yeasts, per mL of digestive tract secretion. Surveillance samples of throat and gut are the only samples to detect overgrowth. Gut overgrowth is the crucial event which precedes both primary and secondary endogenous infection, and a risk factor for the development of de novo resistance. Selective decontamination of the digestive tract (SDD) is an antimicrobial prophylaxis designed to control overgrowth.Methods There have been 65 randomised controlled trials of SDD in 15,000 patients over 25 years and 11 meta-analyses, which are reviewed.Results and conclusions These trials demonstrate that the full SDD regimen using parenteral and enteral antimicrobials reduces lower airway infection by 72 %, blood stream infection by 37 %, and mortality by 29 %. Resistance is also controlled. Parenteral cefotaxime which reaches high salivary and biliary concentrations eradicates overgrowth of 'normal' bacteria such as Staphylococcus aureus in the throat. Enteral polyenes control 'normal' Candida species. Enteral polymyxin and tobramycin, eradicate, or prevent gut overgrowth of 'abnormal' AGNB. Enteral vancomycin controls overgrowth of 'abnormal' methicillin-resistant S. aureus. SDD controls overgrowth by achieving high antimicrobial concentrations effective against 'normal' and 'abnormal' potential pathogens rather than by selectivity.

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Authors: Silvestri, L., de la Cal, M. A., & van Saene, H. K. F.
Venue: Intensive Care Medicine
Publisher: Springer Science and Business Media LLC
Published: 2012-09-22
Volume: 38
Issue: 11
Pages: 1738-1750
ISSN: 0342-4642 (ISSN-L)
1432-1238
DOI: 10.1007/s00134-012-2690-1
OpenAlex: W2065187449
Cited by: 111
References: 156
Citations by year: 2026: 4 · 2025: 7 · 2024: 6 · 2023: 12 · 2022: 7 · 2021: 13 · 2020: 10 · 2019: 4 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 12 · 2013: 16
FWCI: 1.88
Type: journal article
Language: en
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Intensive Care Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords: selective decontamination of the digestive tract, critically ill patients, antibiotic prophylaxis, lower respiratory tract infection, bloodstream infection, mortality, antimicrobial resistance, cefotaxime, polymyxins, tobramycin, vancomycin, methicillin-resistant Staphylococcus aureus, Candida, Staphylococcus aureus, endogenous infection
MeSH terms: Bacterial Infections, Carrier State, Decontamination, Digestive System, Gram-Negative Aerobic Bacteria, Humans, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Critical Illness, Antibiotic Prophylaxis

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Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth

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