Selective digestive decontamination (SDD) refers to the use of antimicrobials to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract to prevent
infections caused by these organisms.
Liver transplant patients are highly vulnerable to
bacterial infection particularly with gram-negative organisms within the first month after
transplantation, and SDD has been proposed as a potential measure to prevent these
infections. However, the benefit of this procedure remains controversial. We undertook a systematic review and meta-analysis to determine whether SDD is beneficial in reducing
infections overall and those caused by gram-negative bacteria in patients following
liver transplantation. All studies that evaluated the efficacy of SDD in
liver transplant patients were included. Randomized trials that included
liver transplant patients given SDD versus either placebo or no treatment or minimal treatment (e.g., oral
nystatin alone), and that provided adequate data to calculate a relative risk ratio, were included in the meta-analysis. Our review shows that most studies found SDD to be effective in reducing gram-negative
infection. The nonrandomized and uncontrolled trials also showed benefit with SDD in reducing overall
infection; however, the effect on overall
infection was limited in the 4 randomized trials, in which the pooled relative risk was 0.88 (95% CI, 0.7-1.1), indicating no statistically significant reduction in
infection with the use of SDD. The summary risk ratio for the association between SDD and gram-negative
infection was 0.16 (95% CI, 0.07-0.37), indicating an 84% relative risk reduction in the incidence of
infection caused by gram-negative bacteria in patients receiving SDD in randomized trials. In conclusion, the available literature supports a beneficial effect of SDD on gram-negative
infection following
liver transplantation; however, the risk of antimicrobial resistance must be considered. Larger multicenter randomized trials in this patient population to assess the effect of SDD in reducing
infection and mortality, while assessing the risk of antimicrobial resistance, are needed.