Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units

• Published in: Intensive care medicine 2013-04, Vol.39 (4), p.653-660
• Main Authors: Oostdijk, Evelien A. N., Smits, Loek, de Smet, Anne Marie G. A., Leverstein-van Hall, Maurine A., Kesecioglu, Jozef, Bonten, Marc J. M.
• Format: Article
• Language: English
• Subjects: Administration, Topical; Anesthesiology; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Bacteria; Cohort Studies; Colistin; Colistin - administration & dosage; Colistin - therapeutic use; Critical Care Medicine; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Multiple, Bacterial - drug effects; Emergency Medicine; Gastrointestinal Tract - drug effects; Gastrointestinal Tract - microbiology; Genotype; Gram-negative bacteria; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - genetics; Humans; Infections; Infectious diseases; Intensive; Intensive care; Intensive Care Units; Medicine; Medicine & Public Health; Microbiology; Multicenter Studies as Topic; Netherlands; Original; Oropharynx - drug effects; Oropharynx - microbiology; Pain Medicine; Pathogens; Patients; Pediatrics; Pneumology/Respiratory System; Randomized Controlled Trials as Topic; Rectum - drug effects; Rectum - microbiology
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-012-2761-3

Purpose Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selective decontamination on acquisition of colistin-resistant gram-negative bacteria (GNB) using data from a cluster-randomized study and a single-centre cohort. Methods Acquisition of colistin-resistant GNB and conversion from susceptible to resistance in GNB was determined in respiratory samples [from patients receiving SDD ( n  = 455), SOD ( n  = 476), or standard care (SC) ( n  = 315)], and in rectal swabs from 1,840 SDD-patients. Genotyping of converting isolates was performed where possible. Results The respiratory tract acquisition rates of colistin-resistant GNB were comparable during SDD, SOD, and SC and ranged from 0.7 to 1.1/1,000 patient-days at risk. Rectal acquisition rates during SDD were  0.05). In patients with rectal GNB carriage conversion rates during SDD were 5.4 and 3.2/1,000 days at risk and 15.5 and 12.6/1,000 days at risk when colonized with tobramycin-resistant GNB. Conclusions Acquisition rates with colistin-resistant GNB in the respiratory tract were low and comparable with and without topical use of colistin. Rates of acquisition of colistin-resistant GNB during SDD were—in ICUs with low endemicity of antibiotic resistance—