Use of Selective Decontamination of the Digestive Tract
Authors: Donald E. Craven
Journal: Annals of Internal Medicine (1992)

Editorials1 October 1992Use of Selective Decontamination of the Digestive TractIs the Light at the End of the Tunnel Red or Green?Donald E. Craven, MDDonald E. Craven, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-117-7-609 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIntensive care units are hallmarks of modern medicine providing the latest in lifesaving, high-tech medicine to critically ill patients (1, 2). More than 95% of hospitals in the United States have at least one critical care unit and tertiary care centers often have several (1). Although intensive care units constitute only 5% of hospital beds and provide care to less than 10% of hospitalized patients, 20% of all hospital infections occur there (1).Twenty to thirty percent of patients in the intensive care unit acquire at least one major nosocomial infection, and some have multiple sites or episodes of infection...References1. PittetHerwaldtMassanari DLR. The intensive care unit. In: Bennett JV, Brachman PS; eds. Hospital Infections. Third edition Boston: Little, Brown and Company, 1991:405-39. Google Scholar2. Maki D. Risk factors for nosocomial infection in intensive care. Devices vs. nature and goals for the next decade. Arch Intern Med. 1989;149:30-5. CrossrefMedlineGoogle Scholar3. CravenKunchesLichtenbergKollischHeerenMcCabe DLDNTW. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med. 1988;148:1161-8. CrossrefMedlineGoogle Scholar4. Weinstein R. Epidemiology and control of nosocomial infections in adult intensive care units. In: Martone WJ, Garner JS; eds. Proceedings of the Third Decennial International Conference on Nosocomial Infections. Am J Med. 1991;3B:179S-84S. CrossrefGoogle Scholar5. JohansonPierceSanfordThomas WAJG. Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract. Ann Intern. Med. 1972;77:701-6. LinkGoogle Scholar6. WenzelThompsonLandryRussellMillerPonce de Leon RRSBPS. Hospital-acquired infections in intensive care unit patients: An overview with emphasis on epidemics. Infect Control. 1983;4:371-5. CrossrefMedlineGoogle Scholar7. Tenover F. Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens. In: Martone WJ, Garner JS; eds. Proceedings of the Third Decennial International Conference on Nosocomial Infections. Am J Med. 1991;3B:76S-81S. CrossrefGoogle Scholar8. PriceSleigh DJ. Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet. 1970;2:1213-5. CrossrefMedlineGoogle Scholar9. HoranCulverJarvisEmoryDanergeeMartone TDWGSW. Pathogens causing nosocomial infections. CDC: The Antimicrobic Newsletter. 1988;5:65-7. CrossrefGoogle Scholar10. Maki D. Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med. 1978;89:777-80. LinkGoogle Scholar11. OlsonWeinsteinNathanChamberlinKabins BRCWS. Occult aminoglycoside resistance in Pseudomonas aruginosa: Epidemiology and implications for therapy and control. J Infect Dis 1985;152:769-74. CrossrefMedlineGoogle Scholar12. MakiMcCormickZilzStolzAlvarado DRMSC. An MRSA outbreak in a SICU during universal precautions: New epidemiology for nosocomial MRSA [Abstract #473] 30th Interscience Conference on Antimicrobial Agents and Chemotherapy. Atlanta, Georgia. 1990:165. Google Scholar13. CravenStegerBarber DKT. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990's. In: Martone WJ, Garner JS; eds. Proceedings of the Third Decennial International Conference on Nosocomial Infections. Am J Med. 1991;44S-53S. CrossrefMedlineGoogle Scholar14. AlbertCondie RF. Handwashing patterns in medical intensive care units. N Engl J Med. 1981;304:1465-6. CrossrefMedlineGoogle Scholar15. HaleyCulverWhiteMorganEmoriMunn RDJWTV. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121:182-205. CrossrefMedlineGoogle Scholar16. TorresSerra-BatllesRosPieraPuig de la BellacasaCobos AJECJA. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: The effect of body position. Ann Intern Med. 1992;116:540-3. LinkGoogle Scholar17. PrestonLarsonStamm GEW. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med. 1981;70:641-5. CrossrefMedlineGoogle Scholar18. DriksCravenCelliManningBurkeGarvin MDBMRG. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers; The role of gastric colonization. N Engl J Med. 1987;317:1376-82. CrossrefMedlineGoogle Scholar19. LepperKofmanBlattDowlingJackson MSNHG. Effect of antibiotics used singly and in combination on the tracheal flora following tracheostomy in poliomyelitis. Antibiot Chemother. 1954;4:829-33. Google Scholar20. KlasterskyHuysmansWeertsHensgensDaneau JEDCD. Endotracheally administered gentamicin for the prevention of infections of the respiratory tract in patients with tracheostomy: a double-blind study. Chest. 1974;65:650-4. CrossrefMedlineGoogle Scholar21. Feeleydu MoulinHedley-WhyteBushnellGilbertFeingold TGJLJD. Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med. 1975;293:471-5. CrossrefMedlineGoogle Scholar22. van SaeneStoutenbeekStoller HCJ. Selective decontamination of the digestive tract in the intensive care unit: Current status and future prospects. Crit Care Med. 1992;20:691-703. CrossrefMedlineGoogle Scholar23. Stoutenbeekvan SaeneMirandaZandstra CHDD. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intens Care Med. 1984;10:185-92. CrossrefMedlineGoogle Scholar24. LedinghamAlcockEastawayMcDonaldMcKayRamsey IAAJIG. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet. 1988;1:785-90. CrossrefMedlineGoogle Scholar25. AerdtsClasenervan DalenVan LierVollaardFesten SHRHEJ. Prevention of bacterial colonization of the respiratory tract and stomach of mechanically ventilated patients by a novel regimen of selective decontamination in combination with initial systemic cefotaxime. J Antimicrob Chemother. 1990;26(Suppl A):59-76. CrossrefMedlineGoogle Scholar26. FlahertyNathanKabinsWeinstein JCAR. Nonabsorbable antibiotics versus sucralfate in preventing colonization and infection in a cardiac surgery intensive care unit. J Infect Dis. 1990;162:1393-7. CrossrefMedlineGoogle Scholar27. Brun-BuissonLegrandRaussRichardMontraversBesbes CPACFM. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli: Study of an outbreak in an intensive care unit. Ann Intern Med. 1989;110:873-81. LinkGoogle Scholar28. McClellandMurrayWilliamsvan SaeneGilbertsonMostafa PAPHAS. Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Crit Care Med. 1990;18:935-9. CrossrefMedlineGoogle Scholar29. UnertlRuckdeschelSelbmannJensenForstLenhart KGHUHF. Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intens Care Med. 1987;13:106-13. CrossrefMedlineGoogle Scholar30. UlrichHarinck-de WeerdBakkerJaczDoornbosde Ridder CWNKLV. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: A prospective randomized study. Intens Care Med. 1989;15:424-31. CrossrefMedlineGoogle Scholar31. PuginAuckenthalerLewSuter JRDP. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia: A randomized, placebo-controlled, double-blind clinical trial. JAMA. 1991;265:2704-10. CrossrefMedlineGoogle Scholar32. KerverRommesMevissen-VerhageHulstaertVosVerhoef AJEPAJ. Prevention of colonization and infection in critically ill patients: A prospective randomized study. Crit Care Med 1988;16:1087-93. CrossrefMedlineGoogle Scholar33. GastinneWolffDelatourFaurissonChevret HMFFS. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med. 1992;326:594-9. CrossrefMedlineGoogle Scholar34. HammondPotgieterSaundersForder JPGA. A double blind study of selective decontamination in Intensive Care. Lancet. 1992;340:5-9. CrossrefMedlineGoogle Scholar35. FerrerTorresGonzalezPuig de la BellacasaGatelRoca MAJJJM. Utility of selective digestive decontamination in a general population of mechanically ventilated patients. Am Rev Respir Dis. 1992;4:A112. Google Scholar36. GodardGuillaumeReverdyBachmannBui-XuanNageotte JCMPBA. Intestinal decontamination in a polyvalent ICU: A double-blind study. Intens Care Med. 1990;16:307-11. CrossrefMedlineGoogle Scholar37. Green V. Microbiological contamination of hospital air. I. Quantitative studies. Appl Microbiol Chem. 1962;561-6. CrossrefMedlineGoogle Scholar38. AshbaughPetty DT. Sepsis complicating the acute respiratory distress syndrome. Surg Gynecol Obstet 1972;135:865-8. MedlineGoogle Scholar39. MackieVan HertumSchumburgKuijperKnape DWTEP. Prevention of infection in burns: Preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries. J Trauma. 1992;32:570-5. CrossrefMedlineGoogle Scholar40. Aerdtsvan DalenClasenerFestenVan LierVollaard SRHJHE. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients: A prospective, blinded, randomized trial of the effect of a novel regimen. Chest. 1991;100:783-91. CrossrefMedlineGoogle Scholar41. CockerillMullerAnhaltMarshFarnellMucha FSJHMP. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med. 1992;117:545-53. LinkGoogle Scholar42. AndrewsCoalsonSmithJohanson CJJW. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest. 1981;80:254-8. CrossrefMedlineGoogle Scholar43. MeduriBealsMaijubBaselski GDAV. Protected bronchoalveolar lavage: A new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis. [Abstract] 1991;143:855-64. CrossrefMedlineGoogle Scholar44. FagonChastreHanceGuiguetTrouilletDomart JJAMJY. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis. 1988;138:110-6. CrossrefMedlineGoogle Scholar45. TorresPuig de la BellacasaXaubetGonzalezRodriguez-RoisinJimenez de Anta AJAJRM. Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis. 1989;140:306-10. CrossrefMedlineGoogle Scholar46. Prod'homLeutenbergerKoerferBlumChloleroSchaller GPJARM. Effect of stress ulcer prophylaxis on nosocomial pneumonia in ventilated patients: A randomized comparative study. 31st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, Illinois. [Abstract #999] 1991. Google Scholar47. KappsteinFriedrichHellingerBenzingGeigerDaschner ITPAKF. Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or Cimetidine as prophylaxis for stress bleeding: Bacterial colonization of the stomach. Am J Med. 1991;91(Suppl 2A):125-31. CrossrefGoogle Scholar48. LeuKaiserMoriWoolsonWenzel HDMRR. Hospital-acquired pneumonia: Attributable mortality and morbidity. Am J Epidemiol. 1989;129:1258-67. CrossrefMedlineGoogle Scholar49. Fink M. Selective digestive decontamination: A gut issue for the nineties. Crit Care Med. 1992;20:559-62. CrossrefMedlineGoogle Scholar50. FoxPetersonFabrivan MSBS. Selective decontamination of the digestive tract in cardiac surgical patients. Crit Care Med. 1991;19:1486-90. CrossrefMedlineGoogle Scholar51. NauRuchelMergerianWegenerWinkelmannPrange RRHUTH. Emergence of antibiotic-resistant bacteria during selective decontamination of the digestive tract. J Antimicrob Chemother. 1990;25:881-3. CrossrefMedlineGoogle Scholar52. Daschner F. Emergence of resistance during selective decontamination of the digestive tract. Eur J Clin Microbiol Infect Dis. 1992;11:1-3. CrossrefMedlineGoogle Scholar53. Weinstein R. Selective intestinal decontamination—an infection control measure whose time has come? Ann Intern Med. 1989;110:853-5. LinkGoogle Scholar54. Selected digestive decontamination in intensive care unit patients. First European Consensus Conference in Intensive Care and Emergency Medicine. Paris, France. 12-13 December 1991. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston University School of Medicine Boston City Hospital Boston, MA 02118 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPathophysiology, Presentation, and Treatment of Conditions Associated with DICPathophysiologie, Klinik und Therapie intensivmedizinischer Krankheitsbilder mit DICReview: Bacterial Translocation and Enteral Nutrition in Humans: An Outsider Looks InNovel approaches to hospital infection controlThe Role of Selective Digestive Tract Decontamination on Mortality and Respiratory Tract InfectionsRisk factors for acquisition of multiply drug-resistant gram-negative bacteriaNeurologic Disease Requiring Long-term VentilationDrug use in infection control — Is more less? 1 October 1992Volume 117, Issue 7Page: 609-611KeywordsDecontaminationGastrointestinal tractIntensive care unitsNosocomial infections Issue Published: 1 October 1992 PDF downloadLoading ...