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. 2018 May 30;22(1):141.
doi: 10.1186/s13054-018-2057-2.

Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance

Catalina Sánchez-Ramírez  1 , Silvia Hípola-Escalada  2 , Miriam Cabrera-Santana  2 , María Adela Hernández-Viera  2 , Liliana Caipe-Balcázar  2 , Pedro Saavedra  3 , Fernando Artiles-Campelo  4 , Nayra Sangil-Monroy  5 , Carlos Federico Lübbe-Vázquez  2 , Sergio Ruiz-Santana  2
Affiliations

Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance

Catalina Sánchez-Ramírez et al. Crit Care. .

Abstract

Background: We examined whether long-term use of selective digestive tract decontamination (SDD) was effective in reducing intensive care unit (ICU)-acquired infection and antibiotic consumption while decreasing colistin-, tobramycin-, and most of the antibiotic-resistant colonization rates in a mixed ICU with a high endemic level of multidrug-resistant bacteria (MDRB).

Methods: In this cohort study, which was conducted in a 30-bed medical-surgical ICU, clinical outcomes before (1 year, non-SDD group) and after (4 years) implementation of SDD were compared. ICU patients who were expected to require tracheal intubation for > 48 hours were given a standard prophylactic SDD regimen. Oropharyngeal and rectal swabs were obtained on admission and once weekly thereafter.

Results: ICU-acquired infections occurred in 110 patients in the non-SDD group and in 258 in the SDD group. A significant (P < 0.001) reduction of infections caused by MDRB (risk ratio [RR], 0.31; 95% CI, 0.23-0.41) was found after SDD and was associated with low rates of colistin- and tobramycin-resistant colonization. Colistin- and tobramycin-acquired increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at admission, was nonsignificant (0.82; 95% CI, 0.56 to 1.95; 1.13; 95% CI, 0.75 to 1.70, respectively). SDD was also a protective factor for ICU-acquired infections caused by MDR gram-negative pathogens and Acinetobacter baumannii in the multivariate analysis. In addition, a significant (P < 0.001) reduction of ventilator-associated pneumonia (VAP) (RR, 0.43; 95% CI, 0.32-0.59) and secondary bloodstream infection (BSI) (RR, 0.35; 95% CI, 0.24-0.52) was found. A decrease in antibiotic consumption was also observed.

Conclusions: Treatment with SDD during 4 years was effective in an ICU setting with a high level of resistance, with clinically relevant reductions of infections caused by MDRB, and with low rates of colistin- and tobramycin-resistant colonization with nonsignificant increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at ICU admission. In addition, VAP and secondary BSI rates were significantly lower after SDD. Notably, a decrease in antimicrobial consumption was also observed.

Keywords: Bloodstream infection; Colistin; Drug resistance; ICU-acquired infection; Multidrug-resistant pathogens; Selective digestive decontamination; Tobramycin; Ventilator-associated pneumonia.

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Conflict of interest statement

Ethics approval and consent to participate

The ENVIN registry was approved by the ethics committees of the majority of participating ICUs, including our hospital, and was declared a registry of healthcare interest by the Spanish Ministry of Health, Social Services and Equality in 2014.

Consent for publication

Not applicable, given the noninterventional nature of the study, because data were collected from the ENVIN-HELICS registry.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flowchart. SDD Selective digestive tract decontamination
Fig. 2
Fig. 2
Summary of study findings. ESBL Extended-spectrum β-lactamase
See this image and copyright information in PMC

References

    1. Oostdijk EAN, Kesecioglu J, Schultz MJ, Visser CE, de Jonge E, van Essen HER, et al. Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial. JAMA. 2014;312:1429–1437. doi: 10.1001/jama.2014.7247. - DOI - PubMed
    1. Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials. J Hosp Infect. 2007;65:187–203. doi: 10.1016/j.jhin.2006.10.014. - DOI - PubMed
    1. Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev. 2009;4:CD000022. - PMC - PubMed
    1. de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360:20–31. doi: 10.1056/NEJMoa0800394. - DOI - PubMed
    1. Halaby T, Al Naiemi N, Kluytmans J, van der Palen J, Vandenbroucke-Grauls CM. Emergence of colistin resistance in Enterobacteriaceae after the introduction of selective digestive tract decontamination in an intensive care unit. Antimicrob Agents Chemother. 2013;57:3224–3229. doi: 10.1128/AAC.02634-12. - DOI - PMC - PubMed

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