Enterococcus faecalis Pneumonia Complicating Topical Antimicrobial Prophylaxis

To the Editor: Selective decontamination of the digestive tract is widely used to prevent nosocomial pneumonia in patients receiving mechanical ventilation, although its benefits are unproved1. Objections to this procedure concern the possible selection of microorganisms resistant to the antibiotics used, rather than adverse effects2. We report eight cases of pneumonia or bacteremia caused by Enterococcus faecalis, as a possible side effect of the prophylactic use of nonabsorbable antimicrobial agents. Sixty-one patients who were receiving mechanical ventilation in the intensive care unit were given topical antimicrobial prophylaxis for the oropharynx and stomach. Tobramycin (40 mg in a 5-ml . . .