The Role of Selective Digestive Tract Decontamination on Mortality and Respiratory Tract Infections
Nosocomial pneumonia accounts for IS to 18 percent of all nosocomial infections in the United States and is the leading cause of patient mortality resulting from nosocomial infection.” The incidence of nosocomial pneumonia in ICUs ranges from 10 to 65 percent with case fatality rates of 13 to 55 percent.” The pathogenesis of nosocomial pneumonia may depend on specific risk factors that predispose to gastric and oropharyngeal colonization with aerobic Gram-negative bacilli. Aspirating these organisms into the lower respiratory tract can, in specific circumstances, overwhelm normal host defenses and lead to pneumonia. Logically, then, the method of selective digestive decontamination (SDD) should decrease the incidence of nosocomial infections, particularly nosocomial pneumonia, in critically ill patients. The goal of SDD is to prevent colonization of the oropharynx and the digestive tract with these potentially pathogenic bacteria by using specifically designed antibiotic regimens that are administered prophylactically. canadian drug mall
These antibiotic regimens have usually targeted aerobic Gram-negative bacilli and fungi.
Several reviews and analyses of SDD have been published recently.” These reviews suggest that SDD may be beneficial in terms of decreasing nosocomial infections, although the effects of SDD on mortality appear to be less clear. Several of these reviews appear to advocate the use of SDD, especially in trauma patients, while others suggest that further investigations are required to identify clear outcome benefits from the use of SDD. Since the publication of these reviews, four new prospective clinical trials of SDD have been published. To further address the issue of SDD in light of these new data, a meta-analysis was performed.
The goal of this meta-analysis was to identify and analyze relevant outcome studies of SDD performed in general ICU populations. For purposes of this analysis, general ICU populations were defined as those comprised of medical, surgical, and trauma patients. Studies involving organ transplant patients and burn patients were not reviewed.
Category: Respiratory Symptoms
Tags: acquired infections, gram-positive bacteria, pneumonia, respiratory infection, tracheobronchitis