LETTER
Selective Decontamination of the Digestive Tract
James R. Johnson
15 May 1993 | Volume 118 Issue 10 | Pages 825-826
TO THE EDITOR:
Because intravenous cefotaxime was part of the prophylactic antimicrobial regimen studied by Cockerill and colleagues [1], it may not be appropriate to characterize this intervention as "selective decontamination of the digestive tract" or to conclude that the study's positive results provide evidence that in nosocomial infections "the gastrointestinal tract is a critical source of pathogenic microorganisms." Cefotaxime penetrates widely throughout the body, reaching concentrations in lung, skin, urine, and serum that are inhibitory for many nosocomial pathogens [2]. Indeed, cefotaxime is an effective treatment for nosocomial pneumonia, bacteremia, and urinary tract infection, as well as soft-tissue infections [3]. That study subjects who received full therapeutic doses of such a widely distributed and potent agent for approximately half of their stay in the intensive care unit would have fewer episodes of urinary and respiratory tract colonization, gram-negative bacteremia, or surgical wound infection than control patients is therefore hardly surprising, irrespective of the co-administration of oral nonabsorbable antimicrobial agents. Although regarded as a secondary component of their prophylactic regimen, intravenous cefotaxime may be primarily responsible for the benefit associated with prophylaxis. The contribution of the oral component would need to be evaluated in a trial comparing the oral agents alone with oral agents plus cefotaxime.
1. Cockerill FR 3d, Muller SR, Anhalt JP, Marsh HM, Farwell MB, Mucha P, et al. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med. 1992; 117:545-53.
2. Gerding DN, Peterson LR, Hughes CE, Bomberger DM. Extravascular antimicrobial distribution in man. In: Lorian V, ed. Antibiotics in Laboratory Medicine. 3d edition. Baltimore, Maryland: William and Wilkins; 1991.
3. Neu HC. The new ß-lactamase-stable cephalosporins. Ann Intern Med. 1982; 97:408-19.
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