Inappropriate dose of enteral antimicrobials promotes resistance

摘要

We read with interest the South African study based on a collection of separate case reports (1). The authors hypothesized that selective digestive decontamination (SDD) using enteral colistin (i.e., polymyxin E) and tobramycin probably contributed to the selection and carriage of a colistin-resistant OXA-181-pro-ducing Klebsiella pneumoniae strain. We argue that the use of an inappropriate protocol of enteral decontamination is more likely responsible for both the failure to eliminate intestinal carriage of K. pneumoniae and the selection of colistin-resistant K. pneumoniae.Interestingly, the authors used their own decontaminating regimen that included a 2 colistin-tobramycin paste applied three times a day into the oropharynx, combined with a solution of 1 million IU colistin and 80 mg tobramycin administered three times a day into the gut via a nasogastric tube. Three main points should be addressed on this decontaminating protocol.