Selective decontamination of the digestive tract (SDD) in critically ill patients: a narrative review.
Bastiaan H J WittekampEvelien A N OostdijkBrian H CuthbertsonChristian Brun-BuissonMarc J M BontenPublished in: Intensive care medicine (2019)
Selective decontamination of the digestive tract (SDD) is an infection prevention measure for intensive care unit (ICU) patients that was proposed more than 30 years ago, and that is currently considered standard of care in the Netherlands, but only used sporadically in ICUs in other countries. In this narrative review, we first describe the rationale of the individual components of SDD and then review the evidence base for patient-centered outcomes, where we distinguish ICUs with low prevalence of antibiotic resistance from ICUs with moderate-high prevalence of resistance. In settings with low prevalence of antibiotic resistance, SDD has been associated with improved patient outcome in three cluster-randomized studies. These benefits were not confirmed in a large international cluster-randomized study in settings with moderate-to-high prevalence of antibiotic resistance. There is no evidence that SDD increases antibiotic resistance. We end with future directions for research.
Keyphrases
- intensive care unit
- end stage renal disease
- risk factors
- healthcare
- chronic kidney disease
- ejection fraction
- high intensity
- newly diagnosed
- mechanical ventilation
- palliative care
- peritoneal dialysis
- double blind
- open label
- randomized controlled trial
- type diabetes
- metabolic syndrome
- phase iii
- skeletal muscle
- adipose tissue
- study protocol
- placebo controlled
- pain management