Selective decontamination of the digestive tract

Abstract

Selective decontamination of the digestive tract (SDD) is an infection prevention technique used in granulocytopenic patients, transplantation surgery and in critically ill intensive care patients. It is based on the observation that many infections are caused by aerobic gram-negative bacteria (Enterobacteriaceae and Pseudomonadaceae), Staphylococcus aureus and yeast spp. carried in the oropharyngeal or intestinal flora (i.e. endogenous infections). It is called selective because the topical antibiotics used for SDD have little effect on the indigenous flora. The indigenous mostly anaerobic flora should be preserved as much as possible because it has important physiological functions and is seldom the cause of infection. More than 10 years after the introduction of SDD in intensive care [1] it is still controversial. In this chapter, the rationale for SDD in intensive care patients and the controversial issues will be discussed.