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,European Journal of Clinical Microbiology & Infectious Diseases

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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
European Journal of Clinical Microbiology & Infectious Diseases ( IF 4.5 ) Pub Date : 2024-03-09 , DOI: 10.1007/s10096-024-04792-0
Alicia Rodríguez-Gascón , Yanire Lloréns-Villar , María Ángeles Solinís , Helena Barrasa , Andrés Canut-Blasco

Purpose

The aim of this study was to to compare the antimicrobial resistance rate and its relationship with the antibiotic consumption in two separate Intensive Care Units (ICUs) of the same hospital, one with and other without selective decontamination of the digestive tract (SDD).

Methods

We performed a retrospective study in the two ICUs of the Araba University Hospital. Trauma and neurosurgical patients are admitted to the SDD-ICU, and general digestive surgery patients go to the no SDD-ICU. From 2014 to 2018 we analyzed the number of isolates, and the bacterial resistance trends of 47 antimicrobial-microorganism combinations. Additionally, antimicrobial consumption was estimated in both ICUs. Resistance rates were also compared with those reported in ENVIN-HELICS Spanish national registry.

Results

In the ICU with SDD protocol, there was a significant decrease in the resistance of E. coli to amoxicillin/clavulanic acid and in the resistance of E. faecalis to high concentration of gentamycin and high concentration of streptomycin. A significant increase of resistance of Staphylococcus coagulasa negative (CoNS) to linezolid in the no SDD-ICU was also detected. Overall, the level of resistance in the SDD-ICU was lower or of the same order than in the ICU without SDD and that reported in the Spanish national registry.

Conclusions

SDD had neither a clinically relevant impact on emergence and spread of resistance, nor in the overall systemic antimicrobial use. The patient type rather than the SDD protocol showed to condition the ecology and therefore, the resistance rate in the ICUs.

中文翻译：

选择性消化道净化 (SDD) 是否会增加抗生素耐药性？同一三级医院的两个重症监护病房（有和没有SDD）的长期比较

目的

本研究的目的是比较同一家医院两个独立重症监护病房 (ICU) 的抗菌素耐药率及其与抗生素消耗的关系，其中一个有选择性消化道净化 (SDD)，另一个没有选择性净化。

方法

我们在阿拉巴大学医院的两个 ICU 进行了回顾性研究。创伤和神经外科患者入住 SDD-ICU，普通消化外科患者入住非 SDD-ICU。从 2014 年到 2018 年，我们分析了 47 种抗菌微生物组合的分离株数量和细菌耐药性趋势。此外，还估计了两个 ICU 的抗菌药物消耗量。耐药率也与 ENVIN-HELICS 西班牙国家登记处报告的耐药率进行了比较。

结果

在采用SDD方案的ICU中，大肠杆菌对阿莫西林/克拉维酸的耐药性以及粪肠球菌对高浓度庆大霉素和高浓度链霉素的耐药性显着下降。在非 SDD-ICU 中还检测到凝固葡萄球菌阴性 (CoNS) 对利奈唑胺的耐药性显着增加。总体而言，SDD-ICU 中的耐药水平低于没有 SDD 的 ICU 或西班牙国家登记处报告的耐药水平。