title: Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study.
abstract: OBJECTIVE
  Despite the evidence, the use of selective decontamination of the digestive tract (SDD) remains controversial, largely because of concerns that it may promote the emergence of antibiotic-resistant strains. The purpose of this study was to evaluate the long-term incidence of carriage of antibiotic-resistant bacteria (ARB), its clinical impact on developing infections and to explore risk factors of acquiring resistance.
  
  
  METHODS
  This study was conducted in one 18-bed medical-surgical intensive care unit (ICU). All consecutive patients admitted to the ICU who were expected to require tracheal intubation for longer than 48 h were given a 4-day course of intravenous cefotaxime, and enteral polymyxin E, tobramycin, amphotericin B in an oropharyngeal paste and digestive solution. Oropharyngeal and rectal swabs were obtained on admission and once a week. Diagnostic samples were obtained on clinical indication.
  
  
  RESULTS
  During 5 years 1,588 patients were included in the study. The incidence density of ARB was stable: 18.91 carriers per 1,000 patient-days. The incidence of resistant Enterobacteriaceae was stable; the resistance of Pseudomonas aeruginosa to tobramycin, amikacin and ciprofloxacin was strongly reduced; there was an increase of P. aeruginosa resistant to ceftazidime and imipenem, associated with the increase in imipenem consumption; the incidence of other nonfermenter bacilli and oxacillin-resistant Staphylococcus aureus was close to zero. Ninety-seven patients developed 101 infections caused by ARB: 23 pneumonias, 20 bloodstream infections and 58 urinary tract infections. Abdominal surgery was the only risk factor associated with ARB acquisition [risk ratio 1.56 (1.10-2.19)].
  
  
  CONCLUSIONS
  Long-term use of SDD is not associated with an increase in acquisition of resistant flora.
authors.affiliation: Intensive Care Unit, Fundación Valle del Lilli, Cali, Colombia.
authors.forename: María E
authors.initials: ME
authors.lastname: Ochoa-Ardila
authors.forename: Ana
authors.initials: A
authors.lastname: García-Cañas
authors.forename: Karen
authors.initials: K
authors.lastname: Gómez-Mediavilla
authors.forename: Ana
authors.initials: A
authors.lastname: González-Torralba
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alía
authors.forename: Paloma
authors.initials: P
authors.lastname: García-Hierro
authors.forename: Nia
authors.initials: N
authors.lastname: Taylor
authors.forename: Hendrick K F
authors.initials: HK
authors.lastname: van Saene
authors.forename: Miguel A
authors.initials: MA
authors.lastname: de la Cal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection; D003666:Decontamination / Q000379:methods*; D024881:Drug Resistance, Bacterial; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies