University Hospital Gent
Gent, Belgium;Correspondence to: Stijn Blot, RN, MA, Department of Intensive Care, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgiou; e-mail: firstname.lastname@example.org
To the Editor:
Based on their prospective study (CHEST; August
1999), Cendrero and colleagues1state that bacteria
colonizing the gut are often responsible for tracheal colonization but
are rarely the cause of nosocomial pneumonia. Indeed, different types
of bacteria causing upper vs lower respiratory tract infections have
been demonstrated before.2 Independent patterns of
colonization may be found in the oropharyngeal and tracheal secretions
from the same patient. For example, enteric Gram-negative bacteria
usually colonize the oropharynx while Pseudomonads favor the lower
The statement that the gastric flora is not a major cause of pneumonia
has been indirectly confirmed by Cook et al,3 who found
that the use of sucralfate instead of H2-antagonists for
stress ulcer prophylaxis had no benefit either in decreasing mortality
or in the incidence of ventilator-associated pneumonia.
Also several unsuccessful trials with selective digestive
decontamination (SDD) with the use of nonabsorbable
antibiotics4–5 argue against theories that consider the
stomach an important source of nosocomial pneumonia in patients on
mechanical ventilation. We hope that the article by Cendrero and
colleagues might convince physicians who still believe in the SDD
concept that there is no evidence for using SDD for the prevention of
ventilator-associated pneumonia, in particular because of its risk for
induction of local antibiotic resistance.5
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