The effects of SDD on mortality

Abstract

Chris Stoutenbeek introduced selective decontamination of the digestive tract (SDD) in intensive care medicine in 1984 [1]. Since than, fifty-six RCTs have been performed, with different end-points. Two of them did not report mortality data. This chapter will focus on the main twenty-eight prospective, randomised studies on mortality in intensive care patients that have been published [2]-[29]. In addition, the meta-analyses on mortality will be discussed. In thirtheen of the published studies the effects of decontamination of both the oral cavity and the rest of the gastrointestinal tract in combination with systemic prophylaxis were investigated [2]-[13], [29], while eight studies investigated the effects of decontamination of the oral cavity and gastrointestinal tract [14]-[21], four studies investigated oral decontamination only [23]-[26], one study examined combined oral decontamination with systemic prophylaxis [22] and four studies investigated the effects of intestinal decontamination only [27, 28, 30, 31]. The published studies not only differed in the combinations of topical and systemic prophylaxis, but also showed wide variations in the antimicrobial agents used. The original SDD schedule (polymyxin, tobramycin, amphotericin combined with cefotaxime) was used in eight studies. In other studies cefotaxime was replaced by ceftriaxone, trimethoprim, ofloxacin, ciprofloxacin or ceftazidime. Tobramycin was sometimes replaced by gentamicin, neomycin, nalidixic acid or norfloxacin. Nystatin sometimes replaced amphotericin B, and in some studies no antifungal agent was given at all. Moreover, in some studies vancomycin was added to the topical agents [32]. © 2008 Springer-Verlag Italia.