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Selective Digestive Decontamination Should Not Be Routinely Employed^*

^* From the Pulmonary and Critical Care Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO.

Correspondence to: Marin H. Kollef, MD, FCCP, Pulmonary and Critical Care Division, Washington University School of Medicine, Campus Box 8052, 660 S. Euclid Ave, St. Louis, MO 63110; e-mail: kollefm{at}msnotes.wustl.edu

There is a general consensus that antimicrobial resistance in the hospital setting has emerged as an important variable influencing patient outcome and resource utilization. Hospitals worldwide are faced with increasingly rapid emergence and spread of antibiotic-resistant bacteria. Both antibiotic-resistant Gram-negative bacilli and Gram-positive bacteria are reported as important causes of hospital-acquired infections. Few antimicrobial agents are available for effective treatment. Selective digestive decontamination (SDD) is a technique aimed at selectively eliminating aerobic Gram-negative bacilli and yeast from the mouth and stomach to reduce the occurrence of hospital-acquired infections, including ventilator-associated pneumonia. Unfortunately, the application of SDD has been associated with emergence of antibiotic-resistant bacterial strains, limiting its overall utility.

Key Words: bacteria • decontamination • hospital • outcomes • pneumonia • resistance

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