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Comparative Study
. 2024 May;43(5):885-893.
doi: 10.1007/s10096-024-04792-0. Epub 2024 Mar 9.

Does selective digestive decontamination (SDD) increase antibiotic resistance? Long-term comparison of two intensive care units (with and without SDD) of the same tertiary hospital

Alicia Rodríguez-Gascón  1   2 , Yanire Lloréns-Villar  3 , María Ángeles Solinís  4   5 , Helena Barrasa  5   6 , Andrés Canut-Blasco  5   7
Affiliations
Comparative Study

Does selective digestive decontamination (SDD) increase antibiotic resistance? Long-term comparison of two intensive care units (with and without SDD) of the same tertiary hospital

Alicia Rodríguez-Gascón et al. Eur J Clin Microbiol Infect Dis. 2024 May.

Abstract

Purpose: The aim of this study was to to compare the antimicrobial resistance rate and its relationship with the antibiotic consumption in two separate Intensive Care Units (ICUs) of the same hospital, one with and other without selective decontamination of the digestive tract (SDD).

Methods: We performed a retrospective study in the two ICUs of the Araba University Hospital. Trauma and neurosurgical patients are admitted to the SDD-ICU, and general digestive surgery patients go to the no SDD-ICU. From 2014 to 2018 we analyzed the number of isolates, and the bacterial resistance trends of 47 antimicrobial-microorganism combinations. Additionally, antimicrobial consumption was estimated in both ICUs. Resistance rates were also compared with those reported in ENVIN-HELICS Spanish national registry.

Results: In the ICU with SDD protocol, there was a significant decrease in the resistance of E. coli to amoxicillin/clavulanic acid and in the resistance of E. faecalis to high concentration of gentamycin and high concentration of streptomycin. A significant increase of resistance of Staphylococcus coagulasa negative (CoNS) to linezolid in the no SDD-ICU was also detected. Overall, the level of resistance in the SDD-ICU was lower or of the same order than in the ICU without SDD and that reported in the Spanish national registry.

Conclusions: SDD had neither a clinically relevant impact on emergence and spread of resistance, nor in the overall systemic antimicrobial use. The patient type rather than the SDD protocol showed to condition the ecology and therefore, the resistance rate in the ICUs.

Keywords: Antimicrobial consumption; Antimicrobial resistance; Critically ill patients; Selective digestive decontamination.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of gram-negative and gram-positive isolates in the two ICUs of the HUA from 2014 to 2018
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