In this study, a team of physicians from France determined whether selective digestive decontamination (SDD) had an impact on bacterial resistance. They evaluated patients receiving nonabsorbable antibiotics and cefazolin.
The researchers assessed 360 multiple trauma patients submitted to SDD over a 6-year period. These patients were compared to 360 control patients who were not receiving SDD.
The SDD consisted of polymyxin E, gentamicin, and amphotericin B applied to the buccal mucosa and provided in the nares and the stomach.
For the first 3 days, systemic cefazolin was also provided.
|Methicillin resistance of Staphylococcus epidermidis was increased.|
|Critical Care Medicine|
The physicians performed resistance analysis in both the cases and controls at predetermined intervals.
The team observed an overgrowth of gram-positive cocci.
They found that methicillin resistance of Staphylococcus epidermidis was increased in the cases. However, resistance of Staphylococcus aureus was not found.
Furthermore, the team determined that the level of resistance of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter to beta-lactamines and aminoglycosides was no different between cases and controls.
Dr Marc Leone's team concluded, "When used in a small subset of patients who have been shown to derive benefit from it (patients who have experienced multiple trauma), SDD has a moderate impact on microbial ecology".
"However, surveillance cultures are indispensable because the absence of resistance to SDD antibiotics determines the long-term safety of the SDD prophylaxis".