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December 1990

Selective Bowel DecontaminationLess Enthusiasm and More Study Is in Order

Author Affiliations

Milwaukee, Wis

Arch Surg. 1990;125(12):1537-1538. doi:10.1001/archsurg.1990.01410240015001

Selective bowel decontamination is a method of antibiotic prophylaxis aimed at reducing the incidence of nosocomial pneumonia and mortality in intubated ventilated patients in the intensive care unit (ICU). It involves the administration of short-term parenteral antibiotics coupled with the application of antibiotic paste to the oral mucous membranes and liquid antibiotics administered via a nasogastric tube for up to 4 weeks. The underlying hypothesis involves these assumptions: First, intubated ventilated patients in the ICU have an increased incidence of nosocomial pneumonia as well as other infections. Second, the bacteria causing these infections are endogenous gram-negative aerobes originating in the gut. Third, control of these infections can be accomplished through antibiotic prophylaxis with no adverse impact on the bacterial ecology of the patient or the ICU environment. Fourth, and most important, use of this complex regimen of antibiotic prophylaxis in intubated, ventilated patients in the ICU results in a decrease

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