The DOI matches its Crossref record; 154 of the 156 references it cites were found in a registry or an index.
Selective decontamination of the digestive tract: the mechanism of action is control of gut overgrowth
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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In the citing paper
“patients who receive SDD are less likely to develop multiorgan failure91 or die96 than patients who do not”
From The microbiome and critical illness (2016) · cites this paper as [96]
In the citing paper
“Since the first (which was also the first positive) randomised controlled trial in 1987,95 SDD has been tested in more than 65 randomised controlled trials studying more than 15000 patients.”
From The microbiome and critical illness (2016) · cites this paper as [96]
In the citing paper
“SDD is the most thoroughly studied intervention in critical care research, and has unambiguous benefits in the prevention of infections, multiorgan failure, and death.”
From The microbiome and critical illness (2016) · cites this paper as [96]
Citations
Cites
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Cited by
Sorted by citations
Dickson, R. P., Singer, B. H., Newstead, M. W., Falkowski, N. R., Erb-Downward, J. R., Standiford, T. J., & Huffnagle, G. B. (2016) · Nature Microbiology · doi:10.1038/nmicrobiol.2016.113 · Cited by 724
The microbiome and critical illness
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The Gut as the Motor of Multiple Organ Dysfunction in Critical Illness
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Metadata
- Authors
- Silvestri, L., de la Cal, M. A., & van Saene, H. K. F.
- Venue
- Intensive Care Medicine
- Published
- 2012-09-22
- Volume
- 38
- Issue
- 11
- Pages
- 1738-1750
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- 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
- 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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