Décontamination digestive : impact en terme d'écologie et de résistance bactérienne, implications pratiques

Despite multiple trials in which a reduction in the incidence of ventilator-associated pneumonia was demonstrated, there are major objections against the routine use of selective digestive decontamination (SDD) including the threat of multiresistant bacteria selection. Antibiotics used in SDD regimen are not active against methicillin resistant Staphylococcus aureus (MRSA). Therefore, SDD is contraindicated in settings where MRSA is endemic. In the other settings, early identification and isolation of MRSA-colonized patients is strongly required. Four trials evaluated antibiotic resistance as primary end points. Their data seem to be reassuring but caution needs to be exercised because all studies were conducted in single center where levels of antibiotic resistance were low. In some of these studies, SDD was applied to a small proportion of patients that led to a low selection pressure due to SDD antibiotics. Moreover, the quality of hygienic procedures was not compared between the control and tested groups. To conclude, SDD is safe and efficient in settings where levels of antibiotic resistance are controlled. Its widespread use requires a continuous microbiological survey.