Ecological Effects of Selective Decontamination on Resistant Gram-negative Bacterial Colonization

Abstract

SOD and SDD have marked effects on the bacterial ecology in an ICU, with rising ceftazidime resistance prevalence rates in the respiratory tract during intervention and a considerable rebound effect of ceftazidime resistance in the intestinal tract after discontinuation of SDD.

Prevention of ventilator-associated pneumonia

“…Surveillance cultures from The Netherlands during decontamination periods had very low rates of antibiotic resistance, with fewer than 5% of isolates resistant to aminoglycosides, ciprofloxacin or ceftazidime [80]. A follow-up study did show a rebound in the prevalence of antibiotic resistant flora after the trial to approximately 10-15% of isolates, but this was similar to rates of resistance prior to decontamination periods [81].…”

The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study

“…The risk of SDD contributing to increased antibiotic resistance was extensively discussed and interviewees used the language of concern, expressing worry, anxiety and fear. This fear would seem to be upheld by the existing evidence on antibiotic resistance [7][8][9]. These findings help us understand why the implementation of SDD has been low in most areas of the world.…”

“…It is clear from these results that, although clinicians' knowledge of the evidence base could be improved, fear of driving antibiotic resistance is a major limiting factor that needs to be more clearly understood before clinicians will implement this regimen [7][8][9]. It is fascinating to reflect that an evidence base suggesting effectiveness in 36 RCT amassed over a 30 year period [1][2][3][4][5][6] is not compelling enough to overcome a perceived risk of driving antibiotic resistance that, to date, has not been upheld in the existing literature [7][8][9]. The interview topic guide was based on a theoretical framework of clinical behaviour [14] which ensured good coverage of potential barriers and facilitators to SDD adoption.…”

“…SDD involves the prophylactic application of topical non-absorbable antibiotics to the oropharynx and stomach with a short course of intravenous antibiotics. Despite much interest over many years and a large evidence base (36 randomised controlled studies) suggesting efficacy in reducing rates of HAIs and increasing survival [1][2][3][4][5][6][7][8][9] SDD has not been widely adopted into intensive care practice worldwide. SDD continues to be a controversial subject, and seems to receive limited support from clinicians [10,11].…”

“…The content of each of the domains is described in Table 1. The controversial nature of SDD and the uncertainty about its evidence base [1][2][3][4][5][6][7][8][9]15,16] suggests that clinicians both within and between different clinical specialities and professional groups may hold opposing views. This study therefore applied Delphi methodology to systematically assess agreement/disagreement with SDD within ICU healthcare professionals.…”