Long-Term Use of Selective Digestive Decontamination in Areas Where Multi-Resistant Bacteria are Endemic. Is it Safe?
Main Article Content
Abstract
Selective digestive decontamination is a prophylactic strategy to reduce the incidence of infection in intensive care unit (ICU) patients by prevention or eradication of the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms in the gut flora that precedes the development of most ICU-acquired infections. It is one of the most studied interventions in critically ill patients. A lot of research have shown that selective digestive decontamination prevents severe infections, reduces mortality, has no adverse effects, is cost-effective and its use does not show a significant increase in antimicrobial resistance in areas of low antibiotic resistance. However, the impact of this in areas where multi-resistant Gram-negative bacteria are endemic is less clear and of great interest. Some studies also comment on the risk of developing infections after discharge from the ICU. The aim of this article is to provide a narrative review of the main evidence supporting or not supporting the use of selective digestive decontamination in these settings, whether it is safe to use in and after ICU discharge and in different types of patients.
Keywords:
selective digestive decontamination, selective decontamination of the digestive tract, oropharyngeal decontamination, intensive care, antibiotic prophylaxis, prevention, resistance, critical ill patient, infection, mortality
Article Details
How to Cite
SÁNCHEZ-RAMÍREZ, Catalina et al.
Long-Term Use of Selective Digestive Decontamination in Areas Where Multi-Resistant Bacteria are Endemic. Is it Safe?.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6188>. Date accessed: 16 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6188.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Van Saene HKF, Damjanovic V, Murray AE, de la Cal MA. How to classify infections in intensive care units the carrier state, a criterion whose time has come? J Hosp Infect. 1996; 33:1-12.
3. Cerdá E, Abella A, de la Cal MA, et al. Enteral vancomycin controls methicillin-resistant Staphylococcus aureus endemicity in an intensive care burn unit: A 9- year prospective study. Ann Surg. 2007; 245:397-407.
4. Silvestri L, van Saene HK, Milanese M, et al. Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial. Eur Respir J. 2004; 23:921-6.
5. Taylor N, van Saene HKF, Abella A, Silvestri L, Vucic M, Peric M. Selective digestive decontamination. Why don’t we apply the evidence in the clinical practice? Med Intensiva. 2007; 31:.3.
6. Tejerina-Álvarez EE, de la Cal López MÁ. Selective decontamination of the digestive tract: concept and application. Med Intensiva (Engl Ed). 2023; 47(10):603-615.
7. Álvarez Lerma F, Sánchez García M, Lorente L, et al. Guidelines for the prevention of ventilator associated pneumonia and their implementation. The Spanish ‘‘Zero-VAP’’ bundle. Med Intensiva. 2014; 38:226-36,
8. Vandenbroucke-Grauls CM, Vandenbroucke JP. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet. 1991; 338:859-62.
9. D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. Br Med. 1998; 316:1275-85.
10. Safdar N, Said A, Lucey MR. The role of selective decontamination for reducing infection in patients undergoing liver transplantation: a systematic review and meta-analysis. Liver Transpl. 2004; 10:817-27.
11. Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 2004; CD000022.
12. Silvestri L, van Saene HK, Milanese M, Gregori D. Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomised controlled trials. Intensive Care Med. 2005; 31:898-910.
13. Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A. Selective decontamination of the digestive tract reduces bloodstream infections and mortality in critically ill patients. Systematic review of randomised, controlled trials. J Hosp Infect. 2007; 65:187-203.
14. Silvestri L, van Saene HK, Casarin A, Berlot G, Gullo A. Impact of selective decontamination of the digestive tract on carriage and infection due to Gram-negative and Gram-positive bacteria: a systematic review of randomised controlled trials. Anaesth Intensive Care. 2008; 36:324-38.
15. Silvestri L, van Saene HK, Weir I, Gullo A. Survival benefit of the full selective digestive decontamination regimen. J Crit Care. 2009;24: 474.e7-14.
16. Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L, Parmenlli E. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev. 009 Oct 7; CD000022.
17. Silvestri L, van Saene HK, Zandstra DF, Marshall JC, Gregori D, Gullo A. Impact of selective decontamination of the digestive tract on multiple organ dysfunction syndrome: systematic review of randomised controlled trials. Crit Care Med. 2010; 38:1370-6.
18. Silvestri L, Milanese M, Taylor N, Piacente N, Zandstra DS, van Saane. Selective digestive decontamination reduces ventilator-associated tracheobronchitis. Respir Med. 2010; 104:1953-5.
19. Price R, MacLennan G, Glen J. SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: Systematic review and network meta-analysis. BMJ. 2014; 348:g2197.
20. Roquilly A, Marret E, Abraham E, Asehnovu K. Pneumonia prevention to decrease mortality in the ICU. A systematic review and metaanalysis. Clin Infect Dis. 2015; 60:64-75.
21. Plantinga NL, de Smet AMGA, Oostdijk EAN, et al. Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: Individual patient data meta-analysis. Clin Microbiol Infect. 2018; 24:505-13.
22. Minozzi S, Pifferi S, Brazzi L, Pecoraro V, Montrucchio G, D’Amico R. Topical antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving mechanical ventilation. Cochrane Database Syst Rev. 2021:CD000022.
23. Hammond NE, Myburgh J, Seppelt I, et al. Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation: A Systematic Review and Meta-analysis. 2022; 328:1922-34.
24. Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984; 10: 185-192.
25. Sánchez-Ramírez C, Hípola-Escalada S, Cabrera-Santana M, et al. Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance. Crit. Care. 2018; 22;141.
26. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter related bloodstream infections in the ICU. N Engl J Med. 2006; 355:2725-32.
27. Vicente-Arranz JL, Sánchez-Ramírez C, Saavedra P, et al. The Relationship between Selective Digestive Decontamination and Nosocomial Infections in Patients Receiving Continuous Renal Replacement Therapy in ICUs: A Multicenter Study, J Clin Med.2024; 13:1.
28. Francis, JJ, Duncan EM, Prior ME, et al. Comparison of four methods for assessing the importance of attitudinal beliefs: An international Delphi study in intensive care settings. Br. J. Health Psychol. 2014; 19: 274-291.
29. De Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N. Engl. J. Med. 2009; 360, 20-31.
30. Buitinck SH, Zandstra DF, van der Voort PH. ICU-acquired candidemia within SDD: low incidence in a 20-year longitudinal database. Intensive Care Med 2016; 42(6):1094-1095.
31. Reizine F, Massart N, Joussellin V, et al. Association between selective digestive decontamination and decreased rate of acquired candidemia in mechanically ventilated ICU patients: a multicenter nationwide study. Critical Care. 2023; 27:1: 494.
32. Ruiz-Santana S, Mora-Quintero ML, Saavedra P, et al. COVID-19 Secondary Infections in ICU Patients and Prevention Control Measures: A Preliminary Prospective Multicenter Study. Antibiotics (Basel). 2022; 11(8):1016.
33. Van der Meer S.B, Figaroa G, van der Voort PHJ, Nijsten MW. Pillay J. Ventilator-associated pneumonia in critically-ill patients with COVID-19 in a setting of selective decontamination of the digestive tract. Crit. Care. 2021; 25, 445.
34. Buil JB, Schouten JA, Wauters J, van de Hoeven H, Verweij PE. Absence of candidemia in critically ill patients with COVID-19 receiving selective digestive decontamination. Intensive Care Medicine. 2022; 48:5 611-612.
35. Gangneux JP, Dannaoui E, Fekkar A, et al. Fungal infections in mechanically ventilated patients with COVID 19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med. 2022; 10(2):180-90.
36. Pérez-Torres D, Martín-Luengo AI, Cuenca-Rubio C, et al. Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study. Med Intensiva 2024; 48:12 677-685.
37. Massart N, Dupin C, Legris E, et al. Prevention of ICU-acquired infection with decontamination regimen in immunocompromised patients: a pre/post observational study. Eur J Clin Microbiol Infect Dis. 2023; 42:10 1163-1172.
38. Hurley JC. Selective digestive decontamination-Con. Intensive Care Med. 2023; 49:982-983.
39. Garrouste-Orgeas M, Timsit JF, Tafflet M, et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis. 2006; 42:1118-1126.
40. Leone M, Bouadma L, Bouhemad, et al. Hospital acquired pneumonia in ICU. Anaesth Crit Care Pain Med. 2018; 37:83.
41. De Waele JJ, Leroux Roels I Depuydt P. Selective digestive decontamination Pro. Intensive Care Med. 2023; 49:979-981.
42. Myburgh JA, Seppelt IM, Goodman F, et al. SuDDICU Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Effect of Selective Decontamination of the Digestive Tract on Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation: A Randomised Clinical Trial. Jama 2022; 328, 1911-1921.
43. Young PJ, Devaux A, Li Q, et al. Selective digestive tract decontamination in critically ill adults with acute brain injuries: a post hoc analysis of a randomised clinical trial. Intensive Care Med. 2024; 50:1 56-67.
44. Wittekamp BH, Plantinga NL, Cooper BS, et al. Decontamination strategies and bloodstream infections with antibiotic resistant microorganisms in ventilated patients: A randomised clinical trial. JAMA. 2018; 320:2087-98.
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