Strategies for prevention of hospital-acquired pneumonia: oral and selective decontamination of the gastrointestinal tract.
The use of antimicrobial prophylaxis is the most extensively studied, though probably also the most controversial, method to prevent the development of ventilator-associated pneumonia (VAP). Selective decontamination of the digestive tract (SDD) includes the application of topical nonabsorbable antibiotics in the oropharynx, stomach, and intestines in combination with systemic antibiotics during the first days of ventilation. Multiple individual studies as well as seven meta-analyses have demonstrated that antimicrobial prophylaxis effectively reduces the incidence of VAP. However, oral decontamination may be as effective as the full SDD regimen in reducing the incidence of late-onset VAP. Moreover, the significant reductions in incidences of VAP have, so far, not resulted in reductions of duration of ventilation and ICU-stay, and reductions in ICU-mortality were found only in meta-analysis. Selection of resistant bacteria is the most important drawback of antimicrobial prophylaxis, and the demonstrated benefits of antimicrobial prophylaxis should be carefully balanced with this potential risk.
Bonten
Marc J M
MJ
Department of Medicine and Dermatology, Division of Acute Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands. m.j.m.bonten@digd.azu.nl