Department of Emergency, Unit of Anaesthesia and Intensive Care, Presidio Ospedaliero di Gorizia, Via Fatebenefratelli 34, 34170 Gorizia, Italy.
Expert Opin Pharmacother. 2012 Jun;13(8):1113-29. doi: 10.1517/14656566.2012.681778. Epub 2012 Apr 25.
Selective decontamination of the digestive tract (SDD) has been proposed to prevent endogenous and exogenous infections and to reduce mortality in critically ill patients. Although the efficacy of SDD has been confirmed by randomized controlled trials (RCTs) and systematic reviews, SDD has been the subject of intense controversy, based mainly on an insufficient evidence of efficacy and on concerns about resistance.
This article reviews the philosophy, the current evidence on the efficacy of SDD and the issue of emergence of resistance. All SDD RCTs were searched using Embase and Medline, with no restriction of language, gender or age. Personal archives were also explored, including abstracts from major scientific meetings; references in papers and published meta-analyses on SDD were crosschecked. Up-to-date evidence of the impact of SDD on carriage, infections and mortality is presented, and the efficacy of SDD in selected patient groups was investigated, along with the problem of the emergence of resistance.
SDD significantly reduces the number of infections of the lower respiratory tract and bloodstream, multiple organ failure and mortality. It also controls resistance, particularly when the full protocol of parenteral and enteral antimicrobials is used.
选择性消化道去污染（SDD）被提议用于预防内源性和外源性感染，并降低重症患者的死亡率。尽管随机对照试验（RCT）和系统评价已经证实了 SDD 的疗效，但 SDD 一直是激烈争议的主题，主要基于疗效证据不足和对耐药性的担忧。
本文回顾了 SDD 的哲学、当前疗效证据以及耐药性出现的问题。使用 Embase 和 Medline 搜索所有 SDD RCT，不限制语言、性别或年龄。还探索了个人档案，包括主要科学会议的摘要；论文中的参考文献和已发表的 SDD 荟萃分析进行交叉核对。目前介绍了 SDD 对携带、感染和死亡率的影响的最新证据，并调查了 SDD 在选定患者群体中的疗效，以及耐药性出现的问题。
SDD 可显著降低下呼吸道和血流感染、多器官衰竭和死亡率的发生。当使用完整的肠内外抗菌药物方案时，它还可以控制耐药性，特别是当使用完整的肠内外抗菌药物方案时。
