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(Chest. 2000;117:1216.)
© 2000 American College of Chest Physicians

Tracheal Colonization in Pneumonia

Stijn Blot, RN, MA; Koenraad Vandewoude, MD; Eric Hoste, MD and Francis Colardyn, MD

University Hospital Gent Gent, Belgium, ; Correspondence to: Stijn Blot, RN, MA, Department of Intensive Care, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgiou; e-mail: icu@rug.ac.be

To the Editor:

Based on their prospective study (CHEST; August 1999), Cendrero and colleagues1 state that bacteria colonizing the gut are often responsible for tracheal colonization but are rarely the cause of nosocomial pneumonia. Indeed, different types of bacteria causing upper vs lower respiratory tract infections have been demonstrated before.2 Independent patterns of colonization may be found in the oropharyngeal and tracheal secretions from the same patient. For example, enteric Gram-negative bacteria usually colonize the oropharynx while Pseudomonads favor the lower respiratory tract.

The statement that the gastric flora is not a major cause of pneumonia has been indirectly confirmed by Cook et al,3 who found that the use of sucralfate instead of H2-antagonists for stress ulcer prophylaxis had no benefit either in decreasing mortality or in the incidence of ventilator-associated pneumonia.

Also several unsuccessful trials with selective digestive decontamination (SDD) with the use of nonabsorbable antibiotics4 5 argue against theories that consider the stomach an important source of nosocomial pneumonia in patients on mechanical ventilation. We hope that the article by Cendrero and colleagues might convince physicians who still believe in the SDD concept that there is no evidence for using SDD for the prevention of ventilator-associated pneumonia, in particular because of its risk for induction of local antibiotic resistance.5

References

  1. Cendrero, JAC, Solé-Violán, J, Benítez, AB, et al (1999) Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 116,462-470[Abstract/Free Full Text]
  2. Geddes, DM (1990) Infection vs colonization. Intensive Care Med 6,201-205
  3. Cook, D, Guyatt, G, Marshall, J, et al (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 338,791-797[Abstract/Free Full Text]
  4. Kollef, MH (1994) The role of selective digestive tract decontamination on mortality and respiratory tract infections: a meta-analysis. Chest 105,1101-1108[Abstract/Free Full Text]
  5. Colardyn, F, Decruyenaere, J, Verschraegen, G, et al (1997) Failure of selective digestive decontamination (SDD) to control an epidemic of colonization by extended spectrum B-lactamase-producing Klebsiella pneumoniae (CAZ) [abstract no. IM-9]. Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy ,365 American Society for Microbiology (Toronto, Canada).




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