Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients

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Abstract
Care of patients in intensive care units (ICUs) is frequently complicated by infections, which are associated with increased morbidity, mortality, and health care costs.1,2 Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) consist of topical antimicrobial agents targeting aerobic gram-negative pathogens, Staphylococcus aureus, and yeasts in the gastrointestinal tract (SDD) and oropharynx (SDD/SOD), and they aim to prevent infections. In ICUs with low levels of antibiotic resistance, SDD and SOD have been associated with improved patient outcomes,3,4 with SDD being more efficacious than SOD.5,6 Currently, SDD and SOD are routinely used in ICUs in the Netherlands, but their use has not been widely adopted in other countries,7 mainly because of limited efficacy data in settings with higher levels of antibiotic resistance and concern about emergence of antibiotic resistance, although the latter is not supported by meta-analyses.8 In contrast, chlorhexidine (CHX) mouthwash is widely used in ICU patients and its use has been associated with a lower incidence of ventilator-associated pneumonia,9,10 with CHX 2% being more efficacious than lower concentrations.9 Yet, in meta-analyses, CHX mouthwash was associated with higher mortality in ICU patients.11,12 SDD and SOD have never been compared head to head with CHX mouthwash in ICU patients.

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