Role of Selective Digestive Decontamination (SDD) in the Prevention of Nosocomial Pneumonia (NP): is Gastric Decontamination Necessary?

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 1992 Jan 1

PMID 1430585

Citations 2

Authors

J Ruiz

J Garcia

M T San Miguel

G Seller

M Bru

C Palazon

Affiliations

Soon will be listed here.

Abstract

In the course of a prospective selective digestive decontamination (SDD) trial to prevent nosocomial pneumonia (NP) during mechanical ventilation (MV), we carried out serial cultures of gastric aspirate to assess the importance of gastric colonization for potential respiratory pathogens and its relationship to the simultaneous gastric pH, to whether the patients were receiving Sucralfate or Ranitidine and to the nutritional biochemical parameters. If NP developed, a bronchial sample was taken by fibreoptic bronchoscopy to determine the causal organisms and its relationship to the previous gastric isolated. Results show: 1) Increase in aerobic Gram negative bacilli colonization during hospitalization. 2) Direct relationship between colonization level and gastric pH. 3) Greater pH in ranitidine vs sucralfate group. 4) Low incidence of NP (11%), the majority of these (66%) being early. 5) No bacteriological correlation between gastric colonization and aetiological agents of NP. 6) Close relationship between pharyngeal colonization and causative germs of pulmonary infection (40%).

Citing Articles

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References

Atherton S, White D . Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet. 1978; 2(8097):968-9. DOI: 10.1016/s0140-6736(78)92530-8. View

Tryba M, Zevounou F, Torok M, Zenz M . Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication. Am J Med. 1985; 79(2C):55-61. DOI: 10.1016/0002-9343(85)90574-1. View

Reusser P, Zimmerli W, Scheidegger D, Marbet G, Buser M, Gyr K . Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. J Infect Dis. 1989; 160(3):414-21. DOI: 10.1093/infdis/160.3.414. View

Lopez A, Carrillo A, Garcia J, Leon J . Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med. 1990; 18(11):1239-42. DOI: 10.1097/00003246-199011000-00011. View

Donowitz L, Page M, Mileur B, Guenthner S . Alteration of normal gastric flora in critical care patients receiving antacid and cimetidine therapy. Infect Control. 1986; 7(1):23-6. DOI: 10.1017/s0195941700063748. View

du Moulin G, PATERSON D, Hedley-Whyte J, Lisbon A . Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet. 1982; 1(8266):242-5. DOI: 10.1016/s0140-6736(82)90974-6. View

Garvey B, McCambley J, Tuxen D . Effects of gastric alkalization on bacterial colonization in critically ill patients. Crit Care Med. 1989; 17(3):211-6. DOI: 10.1097/00003246-198903000-00002. View

Craven D, Daschner F . Nosocomial pneumonia in the intubated patient: role of gastric colonization. Eur J Clin Microbiol Infect Dis. 1989; 8(1):40-50. DOI: 10.1007/BF01964119. View

Daschner F, Kappstein I, Engels I, Reuschenbach K, Pfisterer J, Krieg N . Stress ulcer prophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents?. Infect Control Hosp Epidemiol. 1988; 9(2):59-65. DOI: 10.1086/645786. View

10.

Pingleton S . Enteral nutrition as a risk factor for nosocomial pneumonia. Eur J Clin Microbiol Infect Dis. 1989; 8(1):51-5. DOI: 10.1007/BF01964120. View

11.

Driks M, Craven D, Celli B, Manning M, Burke R, Garvin G . Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987; 317(22):1376-82. DOI: 10.1056/NEJM198711263172204. View

12.

Pingleton S, Hinthorn D, Liu C . Enteral nutrition in patients receiving mechanical ventilation. Multiple sources of tracheal colonization include the stomach. Am J Med. 1986; 80(5):827-32. DOI: 10.1016/0002-9343(86)90623-6. View

13.

Hillman K, Riordan T, OFarrell S, TABAQCHALI S . Colonization of the gastric contents in critically ill patients. Crit Care Med. 1982; 10(7):444-7. DOI: 10.1097/00003246-198207000-00005. View

14.

Craven D, Kunches L, Kilinsky V, Lichtenberg D, Make B, McCabe W . Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis. 1986; 133(5):792-6. View

15.

Stevens R, TERES D, SKILLMAN J, Feingold D . Pneumonia in an intensive care unit. A 30-month experience. Arch Intern Med. 1974; 134(1):106-11. View

16.

Kerver A, Rommes J, Hulstaert P, Vos A, Verhoef J, WITTEBOL P . Colonization and infection in surgical intensive care patients--a prospective study. Intensive Care Med. 1987; 13(5):347-51. DOI: 10.1007/BF00255792. View

17.

Stoutenbeek C, Van Saene H, Miranda D, Zandstra D, LANGREHR D . The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma. 1987; 27(4):357-64. DOI: 10.1097/00005373-198704000-00003. View