Abstract
IntroductionSelective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients’ outcomes. The aim of this study was to determine the effects of long-term use of SDD and SOD on colistin and tobramycin resistance among gram-negative bacteria.MethodsWe performed a post hoc analysis of two consecutive multicentre cluster-randomised trials with crossover of interventions. SDD and SOD were alternately but continuously used during 7 years in five Dutch ICUs participating in two consecutive cluster-randomised trials. In both trials, to measure colistin and tobramycin resistance among gram-negative bacteria, rectal and respiratory samples were obtained monthly from all patients present in the ICU.ResultsThe prevalence of tobramycin resistance in respiratory and rectal samples decreased significantly during long-term use of SOD and SDD. (rectal samples risk ratio (RR) 0.35 (0.23 to 0.53); respiratory samples RR 0.48 (0.32 to 0.73), SDD compared to standard care). Colistin resistance in rectal and respiratory samples did not change (rectal samples RR 0.63 (0.29 to 1.38); respiratory samples RR 1.26 (0.35 to 4.57), SDD compared to standard care).ConclusionsIn this study, in a setting with low antimicrobial resistance rates, the prevalence of resistance against colistin and tobramycin among gram-negative isolates did not increase during a mean of 7 years of SDD or SOD use.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0838-4) contains supplementary material, which is available to authorized users.
Highlights
Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients’ outcomes
During study period I, 1,007 respiratory and 1,093 rectal samples were obtained from 1,189 patients in the five participating ICUs
The prevalence for colistin resistance in rectal samples ranged from 1.2% to 2.8% in study period I, and were 1.7% and 1.1% during SDD and SOD, respectively in study period II (Figure 2)
Summary
Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients’ outcomes. The aim of this study was to determine the effects of long-term use of SDD and SOD on colistin and tobramycin resistance among gram-negative bacteria. Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) aim to eradicate potential pathogenic microorganisms from the digestive tract to prevent infections in intensive care patients. Routine use of SDD and SOD has remained controversial, mainly because of the fear that (long-term) use will increase antibiotic resistance [4,5]. A recent systematic review and meta-analysis failed to demonstrate such an association, and concluded that more evidence is needed regarding the long-term effects of SDD/SOD on ICU ecology [5]. We measured the prevalence of colistin and tobramycin resistance in five ICUs that have continuously been using SDD or SOD for 6 years or longer
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