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. 2022 Sep;48(9):1165-1175.
doi: 10.1007/s00134-022-06826-7. Epub 2022 Aug 11.

Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case-control study over 5 years

Boacheng Wang  1 , Josef Briegel  2 , Wolfgang A Krueger  3 , Rika Draenert  4 , Jette Jung  4   5 , Alexandra Weber  4 , Johannes Bogner  6 , Sören Schubert  5 , Uwe Liebchen  1 , Sandra Frank  1 , Michael Zoller  1 , Michael Irlbeck  1 , Ludwig Ney  1 , Thomas Weig  1 , Ludiwg Hinske  1 , Sebastian Niedermayer  1 , Erich Kilger  1 , Patrick Möhnle  1 , Beatrice Grabein  7
Affiliations

Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case-control study over 5 years

Boacheng Wang et al. Intensive Care Med. 2022 Sep.

Abstract

Purpose: This case-control study investigated the long-term evolution of multidrug-resistant bacteria (MDRB) over a 5-year period associated with the use of selective oropharyngeal decontamination (SOD) in the intensive care unit (ICU). In addition, effects on health care-associated infections and ICU mortality were analysed.

Methods: We investigated patients undergoing mechanical ventilation > 48 h in 11 adult ICUs located at 3 campuses of a university hospital. Administrative, clinical, and microbiological data which were routinely recorded electronically served as the basis. We analysed differences in the rates and incidence densities (ID, cases per 1000 patient-days) of MDRB associated with SOD use in all patients and stratified by patient origin (outpatient or inpatient). After propensity score matching, health-care infections and ICU mortality were compared.

Results: 5034 patients were eligible for the study. 1694 patients were not given SOD. There were no differences in the incidence density of MDRB when SOD was used, except for more vancomycin-resistant Enterococcus faecium (0.72/1000 days vs. 0.31/1000 days, p < 0.01), and fewer ESBL-producing Klebsiella pneumoniae (0.22/1000 days vs. 0.56/1000 days, p < 0.01). After propensity score matching, SOD was associated with lower incidence rates of ventilator-associated pneumonia and death in the ICU but not with ICU-acquired bacteremia or urinary tract infection.

Conclusions: Comparisons of the ICU-acquired MDRB over a 5-year period revealed no differences in incidence density, except for lower rate of ESBL-producing Klebsiella pneumoniae and higher rate of vancomycin-resistant Enterococcus faecium with SOD. Incidence rates of ventilator-associated pneumonia and death in the ICU were lower in patients receiving SOD.

Keywords: Klebsiella pneumoniae/drug effects; Methicillin-resistant Staphylococcus aureus/drug effects; Polymyxins/drug effects; Pseudomonas aeruginosa/drug effects; Selective oral decontamination, selective digestive decontamination, antimicrobial resistance, intensive care units/statistics and numerical data; Vancomycin/drug effects.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the patients in this study. Incidence density was assessed in 3340 patients with SOD and in 1694 patients without SOD (1 >), in 1280 patients with SOD and 1076 patients without SOD admitted to the ICU from the community (2 >), and in 1077 patients with SOD and 372 patients without SOD who were already in hospital but not in the ICU 48 h before admission to the ICU (3 >). For comparison of health care-associated infections and mortality in the ICU, 1694 patients without SOD were compared with corresponding patients with SOD according to a 1:1 propensity score matching (4 >)
Fig. 2
Fig. 2
Incidence densities of MDRB acquired in the ICU in patients with SOD (blue bars) and patients without SOD (orange bars). Significant differences in the annual incidence rates between the groups are marked with an asterisk. There was no significant trend for emergence of MDRB over time in each group
See this image and copyright information in PMC

Comment in

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