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

Critical Care : the Official Journal of the Critical Care Forum
Catalina Sánchez-RamírezSergio Ruiz-Santana

Abstract

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 <  0.001) reduction of infections caused by MDRB (risk ratio [RR], 0.31; 95% CI, 0.23-0.41) was found after SDD and was associated with low rates of colistin- and tobramycin-resistant colonization. Colistin- and tobramycin-acquired increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at admission, was nonsignificant (0.82; 95% CI, ...Continue Reading

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Citations

Jul 4, 2020·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Calypso MathieuMarc Leone
Mar 14, 2019·Digestive Diseases and Sciences·Panomwat AmornphimolthamAsada Leelahavanichkul
May 9, 2019·The Journal of Antimicrobial Chemotherapy·Yanire Lloréns-VillarAlicia Rodríguez-Gascón
Mar 30, 2019·Journal of Intensive Care·Shunsuke Otani, Craig M Coopersmith
Aug 1, 2020·Therapeutic Advances in Gastroenterology·Alexa Choy, Daniel E Freedberg
Jan 23, 2021·The Cochrane Database of Systematic Reviews·Silvia MinozziRoberto D'Amico
Feb 4, 2021·The Journal of Antimicrobial Chemotherapy·Maddalena GiannellaElda Righi
Feb 2, 2019·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·E TacconelliJ Rodríguez-Baño

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