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. 2010 Mar 1;181(5):452-7.
doi: 10.1164/rccm.200908-1210OC. Epub 2009 Dec 3.

Ecological effects of selective decontamination on resistant gram-negative bacterial colonization

Evelien A N Oostdijk  1 , Anne Marie G A de Smet, Hetty E M Blok, Emily S Thieme Groen, Gerard J van Asselt, Robin F J Benus, Sandra A T Bernards, Ine H M E Frénay, Arjan R Jansz, Bartelt M de Jongh, Jan A Kaan, Maurine A Leverstein-van Hall, Ellen M Mascini, Wouter Pauw, Patrick D J Sturm, Steven F T Thijsen, Jan A J W Kluytmans, Marc J M Bonten
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Ecological effects of selective decontamination on resistant gram-negative bacterial colonization

Evelien A N Oostdijk et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) eradicate gram-negative bacteria (GNB) from the intestinal and respiratory tract in intensive care unit (ICU) patients, but their effect on antibiotic resistance remains controversial.

Objectives: We quantified the effects of SDD and SOD on bacterial ecology in 13 ICUs that participated in a study, in which SDD, SOD, or standard care was used during consecutive periods of 6 months (de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, et al. N Engl J Med 2009;360:20-31).

Methods: Point prevalence surveys of rectal and respiratory samples were performed once monthly in all ICU patients (receiving or not receiving SOD/SDD). Effects of SDD on rectal, and of SDD/SOD on respiratory tract, carriage of GNB were determined by comparing results from consecutive point prevalence surveys during intervention (6 mo for SDD and 12 mo for SDD/SOD) with consecutive point prevalence data in the pre- and postintervention periods.

Measurements and main results: During SDD, average proportions of patients with intestinal colonization with GNB resistant to either ceftazidime, tobramycin, or ciprofloxacin were 5, 7, and 7%, and increased to 15, 13, and 13% postintervention (P < 0.05). During SDD/SOD resistance levels in the respiratory tract were not more than 6% for all three antibiotics but increased gradually (for ceftazidime; P < 0.05 for trend) during intervention and to levels of 10% or more for all three antibiotics postintervention (P < 0.05).

Conclusions: SOD and SDD have marked effects on the bacterial ecology in an ICU, with rising ceftazidime resistance prevalence rates in the respiratory tract during intervention and a considerable rebound effect of ceftazidime resistance in the intestinal tract after discontinuation of SDD.

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