Preoperative prophylaxis with SDD in surgical patients

Selective decontamination of the digestive tract (SDD) in surgical patients is an antibiotic strategy to prevent perioperative endotoxaemia and postoperative infections. It does so by eradicating the carriage of aerobic Gram-negative bacilli (AGNB) and fungi in the digestive tract, from oropharynx to rectum [1], while sparing the anaerobic flora. High concentrations of potential pathogenic aerobic Gram-negative bacilli (AGNB) and fungi in the digestive tract may lead to the permeation of bacterial compounds such as endotoxins from the intestinal lumen to the blood, especially if the gut barrier is diminished, which may occur during surgery. The subsequent permeation of endotoxin contributes to a systemic inflammatory response syndrome after the operation [2, 3]. Abnormal colonisation of the digestive tract may also lead to infections in other organ sites, especially if the patient's immune competence is impaired [1]. Abolition of the carrier state may thus prevent gut-derived endotoxaemia and infections. The present contribution focuses on the preoperative use of SDD and discusses reasons for failure.