Does selective digestive decontamination (SDD) increase antibiotic resistance? Long-term comparison of two intensive care units (with and without SDD) of the same tertiary hospital

Rodríguez-Gascón, Alicia; Lloréns-Villar, Yanire; Solinís, María Ángeles; Barrasa, Helena; Canut-Blasco, Andrés

doi:10.1007/s10096-024-04792-0

Cited by 3 publications

References 40 publications

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The Effect of Selective Decontamination on Antimicrobial Resistance in Intensive Care Patients: A Systematic Review and Meta-analysis

Eerten,

Plate,

Groenwold

et al. 2024

Preprint

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Background Selective Digestive Decontamination (SDD) and Selective Oropharyngeal Decontamination (SOD) are applied to prevent infections amongst Intensive Care Unit (ICU) patients and have proven to reduce mortality and infection rates. However, concerns about development of antimicrobial resistance persists, specifically after ICU discharge. The aim of this study was to assess the occurrence of antimicrobial resistance during ICU stay and after ICU discharge in patients who received SDD, or SOD compared to control.Methods A previous systematic review, which included studies on antimicrobial resistance after SDD or SOD from before 01-02-2012, was updated. All studies analyzing antimicrobial resistance during and after ICU stay, were included. Pooled odds ratios and 95% confidence intervals were calculated using the Mantel-Haenszel method with random effects. Analyses were done separately for SDD and SOD.Results Twenty-seven studies were included in the meta-analysis on the occurrence of antimicrobial resistance during ICU stay, yielding a protective association in patients receiving SDD; OR 0.73 (95%-CI 0.54;0.98, I2 75%), less resistance to fluoroquinolones in patients receiving SDD OR 0.29 (95%-CI 0.12;0.68, I2 30%) and less multi-resistant bacteria; OR 0.53 (95%-CI 0.33; 0.87, I2 0%), compared to control treatment. Four studies investigated antimicrobial resistance after ICU discharge of which two were eligible for pooling, which yielded no significant effect; OR 1.20 (95%-CI 0.23;6.36, I2 90%).Conclusion During ICU stay, SDD is associated with reduced antimicrobial resistance to specific antibiotics, in line with a previous review. More specifically combined with intravenous (IV) component, in settings with low prevalence of resistance and in a cluster design. This current review emphasizes the limited amount of data on the long-term effect of antimicrobial decontamination strategies to antimicrobial resistance. Understanding this long-term effect is essential when deciding whether to implement preventative antibiotics in specific subgroups. This could be done by means of a prospective long-term follow-up study.

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The Effect of Selective Decontamination on Antimicrobial Resistance in Intensive Care Patients: A Systematic Review and Meta-analysis

Eerten,

Plate,

Groenwold

et al. 2024

Preprint

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The Relationship between Selective Digestive Decontamination and Nosocomial Infections in Patients Receiving Continuous Renal Replacement Therapy in ICUs: A Multicenter Study

Vicente Arranz,

Sánchez-Ramírez,

Saavedra

et al. 2024

JCM

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Background: Nosocomial infections are a worldwide healthcare issue, especially in intensive care units (ICUs), and they had a prevalence of 21.1% in 2023 in Spain. Numerous predisposing risk factors have been identified, with the most relevant being invasive techniques, including renal replacement therapies (RRTs). Several outstanding strategies have been published that prevent or reduce their incidence, including the nationwide ZERO in Spain, which consists of structured guidelines to be implemented to tackle this problem. One of these strategies, which is defined as ‘highly recommended’ in these projects, is selective digestive decontamination (SDD). The main aim of this study is to compare the incidences of ICU-acquired infections, including those due to multidrug-resistant bacteria (MDRB), in two cohorts of RRT with or without SDD. Methods: We conducted a multicenter, prospective, observational study at two tertiary hospitals in Spain. In total, 140 patients treated with RRT were recruited based on their exposure to SDD. Surveillance microbiological samples and nosocomial infection risk factors were obtained. Infection rates per 1000 days of exposure and the MDRB incidence density ratio were determined. Results: SDD statistically significantly reduced RRT-associated nosocomial infections (OR: 0.10, 95% CI: (0.04–0.26)) and the MDRB incidence density ratio (IDR: 0.156, 95% CI = 0.048–0.506). However, mechanical ventilation (OR: 7.91, 95% CI: (2.54–24.66)) and peripheral vascular disease (OR: 3.17, 95% CI: (1.33–7.56)) were significantly associated with increases in infections. Conclusions: Our results favor the use of SDD in ICU patients with renal failure undergoing CRRT as a tool for infection control.

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Selective Digestive Decontamination: A Comprehensive Approach to Reducing Nosocomial Infections and Antimicrobial Resistance in the ICU

Martínez-Pérez,

Fernández-Fernández,

Morón

et al. 2024

JCM

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Background/Objective: Multidrug-resistant (MDR) bacteria pose a significant threat to global health, especially in intensive care units (ICUs), where high antibiotic consumption drives antimicrobial resistance. Selective digestive decontamination (SDD) is a strategy designed to prevent nosocomial infections and colonization by MDR pathogens. This study aimed to evaluate the impact of implementing an SDD protocol on antibiotic consumption and colonization by carbapenemase-producing Enterobacterale (CPE) in a specific ICU setting. Methods: This quasi-experimental study was conducted in the ICU of a university hospital from June 2021 to June 2023. Patients were divided into two groups: pre-intervention (before SDD) and post-intervention (after SDD implementation). Data on antibiotic consumption (expressed as defined daily doses (DDDs) per 100 stays), nosocomial infections, colonization rates, and the incidence of MDR bacteria were collected. A statistical analysis was conducted to compare the pre- and post-intervention groups. Results: A total of 3266 patients were included, with 1532 in the pre-intervention group and 1734 in the post-intervention group. The implementation of the SDD protocol resulted in a significant reduction in total antibiotic consumption (p = 0.028), with notable decreases in carbapenem use (p < 0.01) and colonization by CPE (p = 0.0099). The incidence of nosocomial infections also decreased in the post-SDD group, although this reduction was not statistically significant. Conclusions: The implementation of the SDD protocol in this ICU setting significantly reduced antibiotic consumption and colonization by CPE. These findings suggest that SDD may be a valuable tool in managing antimicrobial resistance in critical care settings, without contributing to the development of MDR bacteria.

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Does selective digestive decontamination (SDD) increase antibiotic resistance? Long-term comparison of two intensive care units (with and without SDD) of the same tertiary hospital

Cited by 3 publications

References 40 publications

The Effect of Selective Decontamination on Antimicrobial Resistance in Intensive Care Patients: A Systematic Review and Meta-analysis

The Effect of Selective Decontamination on Antimicrobial Resistance in Intensive Care Patients: A Systematic Review and Meta-analysis

The Relationship between Selective Digestive Decontamination and Nosocomial Infections in Patients Receiving Continuous Renal Replacement Therapy in ICUs: A Multicenter Study

Selective Digestive Decontamination: A Comprehensive Approach to Reducing Nosocomial Infections and Antimicrobial Resistance in the ICU

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