Reply to the comment by Fox et al. on “Risk factors for late-onset ventilator associated pneumonia in trauma patients receiving selective digestive decontamination”

Excerpt

Sir: We are pleased to have the opportunity to provide more details about our study [1] in reply to the concerns raised by Fox et al. We agree with Fox and colleagues that the term “outbreak” was unfortunate. The bacteria causing late-onset ventilator-associated pneumonia (VAP) were similar to those generally observed in early-onset VAP. We agree that these bacteria were primarily endogenous, due to a persistent colonization rather than a breakdown in hand hygiene of caregivers, as highlighted in our discussion. We did not describe the oropharyngeal surveillance cultures in the present study, but the effect of selective digestive decontamination (SDD) on samples collected at predetermined intervals in our unit was described in a previous study, which showed the absence of significant effect of SDD on the emergence of Gram-negative bacteria resistance [2]. …