The Antibiotic-Resistance Cost of Selective Decontamination in the ICU

Approaches to preventing hospital-acquired respiratory infections in the intensive care unit (ICU) have included selective oropharyngeal decontamination (SOD) with nonabsorbable antibiotics, either alone or together with a 4-day regimen of an intravenous third-generation cephalosporin to further selectively decolonize the digestive tract (SDD). Although these strategies are not used regularly in the U.S., a prospective controlled trial performed in the Netherlands found a small survival advantage with either approach as compared to standard care (NEJM JW Infect Dis Jan 7 2009). Still, a major concern with both strategies is the potential for increasing the prevalence of antibiotic-resistant bacteria. In a recent cluster-randomized crossover…