Selective Gastrointestinal Decontamination History of recognition and measurement of colonization resistance of the digestive tract as an introduction to selective gastrointestinal decontamination

Abstract

Selective decontamination of the digestive tract was developed following the observation that the digestive tract normally has considerable resistance to colonization by newly ingested bacteria. The research that eventually led to selective decontamination was performed because in the late 1960s and early 1970s, the need for prophylaxis against Gram-negative infections in immuno-compromized patients became evident. At that time, the relatively small number of antibiotics available for therapy of serious infections often lead to treatment failure. To introduce the subject of selective decontamination, this paper, therefore, starts with a short historical overview of the kind of infectious agents as well as the antibiotics available in the 1960s; particularly regarding the type and treatment of infections in severely compromised patients. The fact that the possibilities in infectious diseases were limited was the reason for our experimental search for ways of successful prophylactic treatment with minimal risk of development of resistance.