Selective Decontamination of the Digestive Tract Reduces Pneumonia and Mortality
Table 4
SDD and the emergence of antimicrobial resistance, in areas with high and low endemicity.
Endemicity
Main findings
MRSA
High
Increase of colonization with MRSA [28, 31, 33, 52–55]
Low
No increase of colonization with MRSA [36, 56, 57]
VRE
High
No increase of VRE infection rates [58, 59]; no increase of VRE infection rates when enteral vancomycin is added [26, 56, 60–64]
Low
No increase of VRE carriage [36]; increase of VRE isolates [57]
AGNB
High
Decrease of multiresistant AGNB [54, 65]; lower incidence of carriage and infections with antibiotic resistant Gram-negative bacteria [36, 66–69]; no increase in prevalence of beta lactam- or aminoglycoside-resistant Gram-negative rods [57, 70]; increased antimicrobial resistance [5, 33, 71]
Low
Increased intestinal colonization with Gram-negative bacteria resistant to ceftazidime, tobramycin, or ciprofloxacin—discontinuation of SDD results in a rebound effect of ceftazidime resistant bacteria in the intestinal tract [72]; SDD increased the number of infections caused by multiresistant bacteria [73]
