Chris Stoutenbeek and selective digestive decontamination

Excerpt

In 1983 Chris Stoutenbeek et al. [1] introduced selective digestive decontamination (SDD) as a means of preventing infection in clinical intensive care medicine. The first SDD studies consisted of a series of observations on several different antimicrobial interventions to prevent and treat pathological colonization of the oropharynx, rectum, and organ sites such as the respiratory tract and urinary tract. Stoutenbeek and colleagues made two original observations in these trauma trials: (a) Regarding the pathogenesis of infections, in particular lower airway infections: practically all infections are endogenous, i.e., preceded by throat and/or rectal carriage. Primary endogenous infections due to micro-organisms present in the admission flora are distinguished from secondary endogenous infections due to micro-organisms acquired on the ICU and subsequently carried in throat and gut, i.e., secondary carriage. Approximately 20% of infections are exogenous, i.e., due to micro-organisms not previously carried. (b) Regarding eradication of aerobic Gram-negative bacilli (AGNB) from the oropharynx. This knowledge allowed them to design an antibiotic protocol, a four-component strategy, termed SDD consisting of: (a) parenteral antimicrobials to control primary endogenous infections, (b) enteral antimicrobials to control secondary carriage and subsequent endogenous infections, (c) a high level of hygiene to control exogenous infections, and (d) regular surveillance samples to monitor the efficacy of the SDD protocol. …