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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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Tobramycin resistance in respiratory samples. Prevalence of gram-negative bacteria with intermediate susceptibility (I) or resistant (R) to tobramycin in respiratory samples obtained during study period 1 and 2 respectively.
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Fig5: Tobramycin resistance in respiratory samples. Prevalence of gram-negative bacteria with intermediate susceptibility (I) or resistant (R) to tobramycin in respiratory samples obtained during study period 1 and 2 respectively.

Mentions: The prevalence of tobramycin resistance in rectal samples in study period I was lowest during SDD (6.6%), as compared to standard care (RR 0.54 (0.34 to 0.87) and SOD (RR 0.46 (0.29 to 0.72)) (Figure 4). In study period II, the prevalence was 4.2% during SDD (RR 0.64 (0.40 to 1.04) as compared to SDD in study period I) and 8% during SOD (RR 0.56 (0.39 to 0.78) as compared to SOD in study period I) (Table 1). The prevalence for tobramycin resistance in respiratory samples during SDD in study period I was (6.7%), which was lower than during standard care and SOD (RR 0.61 (0.38 to 1.00) and 0.71 (0.42 to 1.18), respectively). In study period II, the prevalence was 5.3% during SDD (RR 0.78 (0.49 to 1.25) as compared to SDD in study period I) and 4.5% during SOD (RR 0.48 (0.30 to 0.76) as compared to SOD in study period I) (Table 1 and Figure 5).Figure 4


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)

Tobramycin resistance in respiratory samples. Prevalence of gram-negative bacteria with intermediate susceptibility (I) or resistant (R) to tobramycin in respiratory samples obtained during study period 1 and 2 respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Tobramycin resistance in respiratory samples. Prevalence of gram-negative bacteria with intermediate susceptibility (I) or resistant (R) to tobramycin in respiratory samples obtained during study period 1 and 2 respectively.
Mentions: The prevalence of tobramycin resistance in rectal samples in study period I was lowest during SDD (6.6%), as compared to standard care (RR 0.54 (0.34 to 0.87) and SOD (RR 0.46 (0.29 to 0.72)) (Figure 4). In study period II, the prevalence was 4.2% during SDD (RR 0.64 (0.40 to 1.04) as compared to SDD in study period I) and 8% during SOD (RR 0.56 (0.39 to 0.78) as compared to SOD in study period I) (Table 1). The prevalence for tobramycin resistance in respiratory samples during SDD in study period I was (6.7%), which was lower than during standard care and SOD (RR 0.61 (0.38 to 1.00) and 0.71 (0.42 to 1.18), respectively). In study period II, the prevalence was 5.3% during SDD (RR 0.78 (0.49 to 1.25) as compared to SDD in study period I) and 4.5% during SOD (RR 0.48 (0.30 to 0.76) as compared to SOD in study period I) (Table 1 and Figure 5).Figure 4

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