Selective Digestive Decontamination and its Use in Patients with Liver Disease
Zobair M. Younossi
Selective digestive decontamination (SDD) involves the use of antibiotics to enhance the colonisation resistance of the gastrointestinal (GI) tract. This eradicates the Gram-negative organisms and fungi, if antifungals are used, which colonise the GI tract and subsequently cause infections in susceptible hosts. It has been used in patients who are critically ill and in intensive care units, in those who have multiple trauma or neutropenia and in bone marrow transplant recipients. SDD has been used in liver transplant patients perioperatively, in the prophylaxis of spontaneous bacterial peritonitis (SBP) and in acute liver failure. It has been shown to decrease the number of infections, specifically Gram-negative infections, in patients undergoing liver transplantation. SDD is very effective in the primary and secondary prophylaxis of SBP in cirrhotic patients with ascites. The use of the parenteral component of SDD is adequate in patients with acute liver failure. In both liver transplantation and SBP prophylaxis, mortality benefit has not been shown and the emergence of resistant organisms with the use of SDD is a concern.
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