title: Selective decontamination and antibiotic resistance in ICUs.
abstract: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.
authors.affiliation: University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. N.L.Plantinga@umcutrecht.nl.
authors.forename: Nienke L
authors.initials: NL
authors.lastname: Plantinga
authors.affiliation: University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000517:prevention & control*; D002353:Carrier State; D003428:Cross Infection / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D006801:Humans; D007362:Intensive Care Units; D007422:Intestines / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents