ESICM: Low Antibiotic Resistance With ICU Decontamination
Similar mortality for selective decontamination of digestive tract, oropharyngeal decontamination
WEDNESDAY, Oct. 1, 2014 (HealthDay News) -- For patients in intensive care units (ICUs), selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) correlate with low levels of antibiotic resistance. These findings were published online Oct. 1 in the Journal of the American Medical Association to coincide with the annual meeting of the European Society of Intensive Care Medicine, held from Sept. 27 to Oct. 1 in Barcelona, Spain.
Evelien A.N. Oostdijk, M.D., Ph.D., from the University Medical Center Utrecht in the Netherlands, and colleagues conducted a cluster randomized crossover trial comparing 12 months of SOD with 12 months of SDD in 16 Dutch ICUs. Data were included from 5,881 and 6,116 patients for the SOD and SDD regimens, respectively.
The researchers found that the prevalence of antibiotic-resistant gram-negative bacteria was significantly lower in perianal swabs during SDD versus SOD; average prevalence for aminoglycoside resistance was 5.6 and 11.8 percent, respectively (P < 0.001). There were increases in the prevalence of rectal carriage of aminoglycoside-resistant gram-negative bacteria during both interventions -- 7 and 4 percent per month for SDD and SOD, respectively (P = 0.02 for SDD, P = 0.046 for SOD, P = 0.40 for difference). During SOD and SDD, day-28 mortality was 25.4 and 24.1 percent, respectively (P = 0.42). During SOD and SDD, ICU-acquired bacteremia occurred in 5.9 and 4.6 percent of patients, respectively (odds ratio, 0.77; P = 0.002).
"Unit-wide application of SDD and SOD was associated with low levels of antibiotic resistance and no differences in day-28 mortality," the authors write.
One author disclosed financial ties to the medical technology industry.