Selective decontamination of the digestive tract

Infections acquired in the intensive care unit (ICU) often occur during the treatment of critically ill patients, increasing their morbidity, mortality, and healthcare costs. Several studies suggest that the use of prophylactic antibiotic regimens such as selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) can reduce the incidence of nosocomial infections and mortality in ICU patients. The SDD approach is directed toward the following: prevention of secondary colonization with gram-negative bacteria, Staphylococcus aureus, and yeasts through application of nonabsorbable antimicrobial agents in the oropharynx and gastrointestinal tract; preemptive treatment of possible infections caused by commensal respiratory tract bacteria through systemic administration of cephalosporins during the patient’s first 4 days in the ICU; and maintenance of anaerobic intestinal flora through selective use of antibiotics (administered both topically and systemically) without antianaerobic activity.