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. 2023 Feb 10;12(4):1432.
doi: 10.3390/jcm12041432.

Role of Selective Digestive Decontamination in the Prevention of Ventilator-Associated Pneumonia in COVID-19 Patients: A Pre-Post Observational Study

Emanuela Biagioni  1 , Elena Ferrari  1 , Ilenia Gatto  1 , Lucia Serio  1 , Carlotta Farinelli  1 , Irene Coloretti  1 , Marta Talamonti  1 , Martina Tosi  1 , Marianna Meschiari  2 , Roberto Tonelli  3 , Claudia Venturelli  4 , Cristina Mussini  2 , Enrico Clini  3 , Mario Sarti  4 , Andrea Cossarizza  5 , Stefano Busani  1 , Massimo Girardis  1 ; MO-COVID-19 Working Group
Affiliations

Role of Selective Digestive Decontamination in the Prevention of Ventilator-Associated Pneumonia in COVID-19 Patients: A Pre-Post Observational Study

Emanuela Biagioni et al. J Clin Med. .

Abstract

The aim of our study was to evaluate whether the introduction of SDD in a structured protocol for VAP prevention was effective in reducing the occurrence of ventilator-associated pneumonia (VAP) in COVID-19 patients without changes in the microbiological pattern of antibiotic resistance. This observational pre-post study included adult patients requiring invasive mechanical ventilation (IMV) for severe respiratory failure related to SARS-CoV-2 admitted in three COVID-19 intensive care units (ICUs) in an Italian hospital from 22 February 2020 to 8 March 2022. Selective digestive decontamination (SDD) was introduced from the end of April 2021 in the structured protocol for VAP prevention. The SDD consisted of a tobramycin sulfate, colistin sulfate, and amphotericin B suspension applied in the patient's oropharynx and the stomach via a nasogastric tube. Three-hundred-and-forty-eight patients were included in the study. In the 86 patients (32.9%) who received SDD, the occurrence of VAP decreased by 7.7% (p = 0.192) compared to the patients who did not receive SDD. The onset time of VAP, the occurrence of multidrug-resistant microorganisms AP, the length of invasive mechanical ventilation, and hospital mortality were similar in the patients who received and who did not receive SDD. The multivariate analysis adjusted for confounders showed that the use of SDD reduces the occurrence of VAP (HR 0.536, CI 0.338-0.851; p = 0.017). Our pre-post observational study indicates that the use of SDD in a structured protocol for VAP prevention seems to reduce the occurrence of VAP without changes in the incidence of multidrug-resistant bacteria in COVID-19 patients.

Keywords: COVID-19; acute respiratory distress syndrome; intensive care unit; mechanical ventilation; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative probability of developing ventilator-associated pneumonia after initiation of invasive mechanical ventilation in patients receiving (solid line) and non-receiving (dotted line) selective digestive decontamination.
See this image and copyright information in PMC

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