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

• Published in: Critical care (London, England) England), 2018-05, Vol.22 (1), p.141-141, Article 141
• Main Authors: Sánchez-Ramírez, Catalina, Hípola-Escalada, Silvia, Cabrera-Santana, Miriam, Hernández-Viera, María Adela, Caipe-Balcázar, Liliana, Saavedra, Pedro, Artiles-Campelo, Fernando, Sangil-Monroy, Nayra, Lübbe-Vázquez, Carlos Federico, Ruiz-Santana, Sergio
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacteria; Bacterial Infections - prevention & control; Bloodstream infection; Cohort Studies; Colistin; Colistin - administration & dosage; Colistin - therapeutic use; Critical care; Cross infection; Decontamination - methods; Decontamination - standards; Dosage and administration; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Bacterial - physiology; Female; Gastrointestinal Tract - physiopathology; Gram-negative bacteria; Health surveillance; Humans; ICU-acquired infection; Intensive care; Intensive Care Units - organization & administration; Intubation; Male; Microorganisms; Middle Aged; Mortality; Multidrug resistant organisms; Multidrug-resistant pathogens; Nosocomial infections; Ostomy; Pneumonia; Prevention; Prospective Studies; Protective Factors; Selective digestive decontamination; Spain; Staphylococcus infections; Systematic review; Tobramycin; Tobramycin - administration & dosage; Tobramycin - therapeutic use; Ventilator-associated pneumonia; Ventilators
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-018-2057-2

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). 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. ICU-acquired infections occurred in 110 patients in the non-SDD group and in 258 in the SDD group. A significant (P