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REPLY
Selective Decontamination of the Digestive Tract and Prevention of Ventilator-Associated Pneumonia
Harold R. Collard, MD;
Sanjay Saint, MD, MPH; and
Michael A. Matthay, MD
5 October 2004 | Volume 141 Issue 7 | Pages 577-578
IN RESPONSE:
Whether the use of SDD leads to ensuing antimicrobial resistance remains a central and unresolved debate in critical care medicine. Baines and van Saene's careful review of newly published articles on this topic adds important information to this debate. Although these data support the argument that SDD does not lead to increased antimicrobial resistance, the published literature still does not provide a definitive answer. We hope that Drs. Baines and van Saene would agree that incorporating the debate over antimicrobial resistance (and the existence of data to support its potential link with SDD) into our recommendations regarding the routine use of SDD was justified. The potential link between SDD and antimicrobial resistance was recently expressed by Dodek and colleagues in their evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia (1): "We make no recommendations regarding selective digestive decontamination using intravenous and topical antibiotics because of insufficient data about antibiotic resistance." Therefore, in the absence of data that clearly decide this important issue, we stand by our statement that the routine use of SDD should not be recommended.
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Author and Article Information
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From University of Colorado Health Sciences Center, Denver, CO 80262; Ann Arbor Veterans Affairs Medical Center and the University of Michigan Health System, Ann Arbor, MI 48109; and University of California, San Francisco, San Francisco, CA 94143.
1. Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004;141:305-13. [PMID: 15313747].[Abstract/Free Full Text]
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Reviews
Prevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review
Harold R. Collard, Sanjay Saint, AND Michael A. Matthay
- Annals 2003 138: 494-501.
[ABSTRACT][SUMMARY][Full Text]
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