Prevention of ventilator-associated pneumonia by selective decontamination of the digestive tract: Table 1—

Prevention of ventilator-associated pneumonia by selective decontamination of the digestive tractTo the Editors:We read with interest the review entitled ''Evidence on measures for the prevention of ventilator-associated pneumonia'' by LORENTE et al. [1].We enjoyed the paper as it is comprehensive and based on an appropriate design.In particular, we welcome the authors' acknowledgement of the proven clinical benefits of selective decontamination of the digestive tract (SDD).The authors give four explanations why SDD is not yet widely used, but are unable to make a definitive recommendation regarding its use due to the perceived ''lack of consistent benefit and unclear cost-effectiveness''.Overall, 20 yrs of clinical research have yielded 56 randomised controlled trials (RCTs) of SDD and 12 meta-analyses [2].SDD significantly reduced the odds ratio (95% confidence interval) for pneumonia [3], bloodstream infection [4] and mortality [3] to 0.35 (0.29-0.41), 0.63 (0.46-0.87) and 0.78 (0.68-0.89), respectively.Concerns expressed by the experts about resistance are based on low-level evidence but have hindered the implementation of SDD.Resistance was practically absent in 56 RCTs of SDD [5].In particular, a large Dutch RCT including the end-point of resistance demonstrated that carriage of multiresistant, aerobic, TABLE 1 Summary of randomised controlled trials of selective decontamination of the digestive tract, including data on costs First author [Ref.]Cost measure Comment ABELE-HORN [8] Patients treated with antibiotics Significantly reduced Antibiotic expenditure Reduced Antibiotic cost?day -1 ?patient -1 Significantly reduced Antibiotic cost?patient -1 treated Significantly reduced Ventilation cost?day -1 No difference