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Colistin and tobramycin resistance during long- term use of selective decontamination strategies in the intensive care unit: a post hoc analysis.

Wittekamp BH, Oostdijk EA, de Smet AM, Bonten MJ - Crit Care (2015)

Bottom Line: Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients' outcomes.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).In 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.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. B.H.J.Wittekamp@umcutrecht.nl.

ABSTRACT

Introduction: 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.

Methods: We 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.

Results: The 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).

Conclusions: In 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.

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Time line of the two consecutive studies and interval period. (a) In both studies interventions were separated by a one month wash-in wash-out period (not shown) [3,6]. The baseline period is the control period in which ICUs used standard care, not including SDD or SOD. All centres continued SDD in the interval period (grey). The end of the intervention period marks the end of the study. ICU, intensive care unit; SDD, selective digestive tract decontamination; SOD, selective oropharyngeal decontamination.
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Fig1: Time line of the two consecutive studies and interval period. (a) In both studies interventions were separated by a one month wash-in wash-out period (not shown) [3,6]. The baseline period is the control period in which ICUs used standard care, not including SDD or SOD. All centres continued SDD in the interval period (grey). The end of the intervention period marks the end of the study. ICU, intensive care unit; SDD, selective digestive tract decontamination; SOD, selective oropharyngeal decontamination.

Mentions: The average duration of SDD/SOD use per ICU was 7.05 years (range 6.8 to 7.5 years), excluding the 6-month standard care period of study period I. A timeline of the two studies can be found in Figure 1. During study period I, 1,007 respiratory and 1,093 rectal samples were obtained from 1,189 patients in the five participating ICUs. During study period II, 1,755 respiratory and 1,808 rectal samples were obtained from 1,865 patients.Figure 1


Colistin and tobramycin resistance during long- term use of selective decontamination strategies in the intensive care unit: a post hoc analysis.

Wittekamp BH, Oostdijk EA, de Smet AM, Bonten MJ - Crit Care (2015)

Time line of the two consecutive studies and interval period. (a) In both studies interventions were separated by a one month wash-in wash-out period (not shown) [3,6]. The baseline period is the control period in which ICUs used standard care, not including SDD or SOD. All centres continued SDD in the interval period (grey). The end of the intervention period marks the end of the study. ICU, intensive care unit; SDD, selective digestive tract decontamination; SOD, selective oropharyngeal decontamination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4373110&req=5

Fig1: Time line of the two consecutive studies and interval period. (a) In both studies interventions were separated by a one month wash-in wash-out period (not shown) [3,6]. The baseline period is the control period in which ICUs used standard care, not including SDD or SOD. All centres continued SDD in the interval period (grey). The end of the intervention period marks the end of the study. ICU, intensive care unit; SDD, selective digestive tract decontamination; SOD, selective oropharyngeal decontamination.
Mentions: The average duration of SDD/SOD use per ICU was 7.05 years (range 6.8 to 7.5 years), excluding the 6-month standard care period of study period I. A timeline of the two studies can be found in Figure 1. During study period I, 1,007 respiratory and 1,093 rectal samples were obtained from 1,189 patients in the five participating ICUs. During study period II, 1,755 respiratory and 1,808 rectal samples were obtained from 1,865 patients.Figure 1

Bottom Line: Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients' outcomes.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).In 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.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. B.H.J.Wittekamp@umcutrecht.nl.

ABSTRACT

Introduction: 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.

Methods: We 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.

Results: The 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).

Conclusions: In 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.

Show MeSH