Selective digestive decontamination, a seemingly effective regimen with individual benefit or a flawed concept with population harm?

• Published in: Critical care (London, England) Vol. 25; no. 1; pp. 1 - 323
• Main Author: Hurley, James C
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 01.09.2021; BioMed Central; BMC
• Subjects: Antibiotics; Bacteremia; Chemotherapy; Critical care; Diagnosis; Disease prevention; Dosage and administration; Drug therapy; Experiments; Hematology; Infections; Mechanical ventilation; Mortality; Neutropenia; Oral administration; Patients; Polymyxin; Radiation; Selective digestive decontamination; Testing; Ventilation; Ventilators; Viewpoint; Yeast; Australia
• ISSN: 1364-8535; 1364-8535; 1466-609X; 1366-609X
• DOI: 10.1186/s13054-021-03744-w

Abstract Selective digestive decontamination (SDD) regimens, variously constituted with topical antibiotic prophylaxis (TAP) and protocolized parenteral antibiotic prophylaxis (PPAP), appear highly effective for preventing ICU-acquired infections but only within randomized concurrent control trials (RCCT’s). Confusingly, SDD is also a concept which, if true, implies population benefit. The SDD concept can finally be reified  in humans using the broad accumulated evidence base, including studies of TAP and PPAP that used non-concurrent controls (NCC), as a natural experiment. However, this test implicates overall population harm with higher event rates associated with SDD use within the ICU context.