Infection rates in the ICU population may increase to 80 percent as the duration of stay go beyonds 5 days.

Infection rates in the ICU population may increase to 80 percent as the duration of stay go beyonds 5 days, causing considerable morbidity, mortality, and increased health care costs[1] The incidence of nosocomial pneumonia in prospective cohort studies ranges from 10 to 65 percent with case fatality rates from 13 to 55 percent[23] Overall, pneumonia is the secondary most frequent cause of hospital-acquired infection and the leading cause of morality related to nosocomial infections.[4]

Selective decontamination of the digestive tract (SDD) is the prophylactic use of topical, nonabsorbable, and sometimes intravenous antibiotics to eradicate pathogenic microorganisms from the gastrointestinal tract in an attempt to render the incidence of respiratory tract infections and mortality rates in critically ill patients. Selective eradication of potentially pathogenic intestinal bacteria leaves the commensal anaerobic flora intact, thereby preventing colonization and overgrowth of resistant pathogenic organisms. The rationale for the use of SDD is based onward the fact that gastrointestinal overgrowth with pathogenic bacteria plays a causal part in the development of nosocomial pneumonia[5] and multiple organ dysfunction.[6] Oropharyngeal colonization with pathogenic bacteria be met withs within the first few days of admission to the ICU.[7] The gastrointestinal tract is pondering to be the source of similar bacteria. Retrograde transmission of contaminated gastric satisfieds to the orpharynx and posterior aspiration of these organisms predisposes the ICU patient to nosocomial pneumonia.[8] In addition, the bacterial load of the gastrointestinal tract in the demeanor of a compromised intestinal mucosal barrier may conclusion in "translocation" of bacteria and/or endotoxin from the embowel lumen into the circulation. Translocation is believed to be an important etiologic fact in the development of ICU-acquired infection[9] and multiple organ failure.[6]

The objective of this overview is to evaluate the efficiency of SDD on respiratory tract infections and mortality in adult ICU patients.

scan of Reviews

Since the original publication of Stoutenbeck et al[10] of SDD several studies have evaluated various forms of SDD in different populations, including pediatric, organ transplant, exquisiteed postoperative, and adult ICU patients. Various combinations of topical, nonabsorbable antibiotics and antifungals have been used. a certain number of trials have included prophylactic systemic antibiotics that are notion to be useful in treating infections contracted prior to ICU admission, and in preventing colonization and infection prior to the establishment of effective decontamination with topical antibiotics.

Although mostly trials of SDD have hinted a favorable impact on pneumonia, the definitions of pneumonia have been variable, and the weights on mortality and duration of ICU stay have been inconsistent. Several qualitative[11-16] and single quantitative review article[17] have summarized these data.

Since then, several other high-quality trials of SDD have been directioned Moreover, the quantitative review has several limitations, based onward standard criteria developed for evaluating scientific overviews.[18] The authors did not search for unpublished articles, raising make uneasys about the threat of publication bias because of the exclusion of unpublished material.[19] Neither the criteria used to pick articles for inclusion in the overview nor assessment of the methodologic rigor of the primary articles was stated explicitly. Les than half the articles reported in the overview were randomized trials; studies with different definitions of pneumonia were combined; and studies reporting the incidence of pneumonia using the number of infections were aggregated with studies reporting the number of patients. Finally, there was no exploration for sources of heterogeneity in trial comes The foregoing limitations and the addition of modern SDD studies to the literature warrant a passing from hand to hand scientific overview of this topic.

Herein, we report our synthesis of the evidence in an overview of 25 randomized trials of SDD

METHODS

studious mood Identification

We used four processs to locate primary research for this overview. First, we searched MEDLINE database for the years 1966 to 1992 using the following explanation words: "decontamination or prophylaxis"; displode "intensive care units"; explode "antibiotics"; "prospective or random"; "drug therapy"; "prevention and control"; and "respiratory tract infections." secondary we searched unpublished reports forward the following databases: Bioses previews, Federal Research in Progres discourse Papers Index, NTIS, and UNIVRES (formerly Information Exchange Center [IEC]). Search terminuss included gastrointestinal, decontamination, antibiotic prophylaxis, critical or intensive care. Third, our avow files and personal communication with authors of primary studies provided additional citations. Finally, we reviewed the regard lists of all available review articles and primary studies to identify intimations not found in the computerized searches.

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