Hospital acquired infections are a major cause of morbidity and mortality. Critically ill patients in Intensive Care Units (ICUs) are particularly susceptible to these infections. One intervention that has gained much interest in the medical literature for reducing infection rates and deaths from hospital acquired infections is selective decontamination of the digestive tract (SDD). SDD involves the application of antibiotic pastes to the mouth, throat and stomach and a short course of antibiotics into a vein.

Previous research undertaken in HSRU (funded by NIHR) showed that there was considerable ongoing uncertainty about possible benefits and harms of SDD and that further large-scale effectiveness trials of SDD in ICUs would be required to address these uncertainties, especially the effect of SDD on antimicrobial resistance. Funding has now been received in Australia & New Zealand (from the Australian National Health and Medical Research Council) and Canada (from the Canadian Institutes of Health Research) to run international trials to a shared protocol (with a cluster-crossover design focusing on the effects of SDD on mortality and antimicrobial resistance). Patients are also being recruited from the UK. HSRU researchers are engaged in the international oversight of these trials, and also directly as co-applicants in the design, conduct and implementation of SUDDICU Canada - which is also seeking funding to undertake a parallel process evaluation.





Francis JJ, Duncan EM, Prior ME, MacLennan GS, Dombrowski SU, Bellingan G, Campbell MK, Eccles MP, Rose L, Rowan KM, Shulman R, Wilson APR, Cuthbertson BH. Selective decontamination of the digestive tract in critically ill patients treated in Intensive Care Units: a mixed-methods feasibility study (the SuDDICU study). Health Technology Assessment, 2014; Vol 18.

Cuthbertson BH, Campbell MK, MacLennan G, Duncan EM, Marshall AP, Wells EC, Prior ME, Todd L, Rose L, Seppelt IM, Bellingan G, Francis JJ. Clinical stakeholders' opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units: an international Delphi study. Critical Care 2013, 17:R266

Marshall A.P, Weisbrodt L, Rose L, Duncan E, Prior M, Todd L, Wells E, Seppelt I, Cuthburtson B, Francis J.J. Implementing Selective Digestive Decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations, Heart & Lung 2013;1-6 doi: 10.1016/j.hrtlng.2013.09.002

Francis JJ, Duncan EM, Prior ME, MacLennan G, Marshall AP, Wells EC, Todd L, Rose L, Campbell MK, Webster F, Eccles MP, Bellingan G, Seppelt IM, Grimshaw JM, and Cuthbertson BH, for the SuDDICU study groups. Comparison of four methods for assessing the importance of attitudinal beliefs: An international Delphi study in intensive care settings. British Journal of Health Psychology, 2013 doi: 10.11 11/bjhp.1 2066

Dombrowski SU, Prior M, Duncan E, Cuthbertson BH, Bellingan G, Campbell MK, Rose L, Binning AR, Gordon AC, Wilson P, Shulman R, Francis JJ. Specifying clinical and behavioural components of a complex healthcare intervention:  Case studies of selective decontamination of the digestive tract in intensive care. Special issue in Infection Control, Australian Critical Care, 26 (2013), pp. 173-179 doi:10.1016/j.aucc.2013.04.002