Selective decontamination of digestive tract in intensive care

Since de Jonge and colleagues elected not to switch the SDD regimen from one ICU to the other somewhere through their observation period, it is very difficult to ascribe differences in outcomes to the use of the SDD regimen alone. [...]de Jonge and colleagues did not properly examine the risk of the emergence of antibiotic resistance due to SDD. Since application of large quantities of antimicrobial agents to mucosal surfaces will eradicate much of the aerobic microbial flora, and might well mask the selection or acquisition of resistance clones as long as SDD is given, the true risk of fostering resistance emergence should have been assessed by using special, SDD-neutralising media for culture while patients were on SDD, and by monitoring the recolonisation of the patients' digestive tracts after they were discharged from the ICU and the hospital.