Summary
From the point of view of prevention, it is useful to divide infections in intensive care into exogenous infections and primary or secondary endogenous infections. Exogenous infections hardly play a role nowadays. With selective decontamination of the digestive tract (SDD) secondary endogenous infections can be effectively prevented, but for primary endogenous infections SDD comes too late. Primary endogenous infection is the major infectious problem in intensive care. A large number of these infections are postoperative infections and are responsible for a high morbidity and mortality in the intensive care unit. Many of these postoperative infections might be prevented if SDD were started before instead of after the operation when the patient is admitted to the ICU. A tentative list of indications for pre-operative SDD is presented with a flow diagram to determine the optimal infection prevention regimen.
Zusammenfassung
Vom Gesichtspunkt der Infektionsprophylaxe ist es sinnvoll, in der Intensivmedizin zu unterscheiden in exogene Infektionen und primär- oder sekundär endogene Infektionen. Exogene Infektionen spielen kaum eine Rolle heutzutage. Mit selektiver Dekontamination des Verdauungstraktes können sekundär endogene Infektionen effektiv verhütet werden, aber nicht die primär endogenen Infektionen. Die primär endogenen Infektionen sind verantwortlich für eine erhebliche Morbidität und Mortalität in der Intensivstation. Eine große Zahl dieser Infektionen sind post-operative Infektionen, die vermeidbar wären, wenn die selektive Dekontamination vor der Operation durchgeführt würde, statt nachher, wenn der Patient in der Intensivstation aufgenommen wird. Eine Liste von Indikationen für prä-operative selektive Dekontamination wird in Verbindung mit einem Schema für eine optimale Infektionsprophylaxe aufgestellt.
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Stoutenbeek, C.P., van Saene, H.K.F. How to improve infection prevention by selective decontamination of the digestive tract (SDD). Infection 18 (Suppl 1), S10–S13 (1990). https://doi.org/10.1007/BF01644480
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DOI: https://doi.org/10.1007/BF01644480