The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study
Abstract Background The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly acquired antimicrobial resistance of aerobic gram-negative potentially pa...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2480-z |
| _version_ | 1830460021344829440 |
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| author | Sophie Buitinck Rogier Jansen Saskia Rijkenberg Jos P. J. Wester Rob J. Bosman Nardo J. M. van der Meer Peter H. J. van der Voort |
| author_facet | Sophie Buitinck Rogier Jansen Saskia Rijkenberg Jos P. J. Wester Rob J. Bosman Nardo J. M. van der Meer Peter H. J. van der Voort |
| author_sort | Sophie Buitinck |
| collection | DOAJ |
| description | Abstract Background The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly acquired antimicrobial resistance of aerobic gram-negative potentially pathogenic bacteria (AGNB) during SDD. Methods In a single-centre observational cohort study over a 21-year period, all consecutive patients, treated with or without SDD, admitted to the ICU were included. The antibiotic regime was unchanged over the study period. Incidence rates for ICU-acquired AGNB’s resistance for third-generation cephalosporins, colistin/polymyxin B, tobramycin/gentamicin or ciprofloxacin were calculated per year. Changes over time were tested by negative binomial regression in a generalized linear model. Results Eighty-six percent of 14,015 patients were treated with SDD. Most cultures were taken from the digestive tract (41.9%) and sputum (21.1%). A total of 20,593 isolates of AGNB were identified. The two most often found bacteria were Escherichia coli (N = 6409) and Pseudomonas (N = 5269). The incidence rate per 1000 patient-day for ICU-acquired resistance to cephalosporins was 2.03, for polymyxin B/colistin 0.51, for tobramycin 2.59 and for ciprofloxacin 2.2. The incidence rates for ICU-acquired resistant microbes per year ranged from 0 to 4.94 per 1000 patient-days, and no significant time-trend in incidence rates were found for any of the antimicrobials. The background prevalence rates of resistant strains measured on admission for cephalosporins, polymyxin B/colistin and ciprofloxacin rose over time with 7.9%, 3.5% and 8.0% respectively. Conclusions During more than 21-year SDD, the incidence rates of resistant microbes at the ICU level did not significantly increase over time but the background resistance rates increased. An overall ecological effect of prolonged application of SDD by counting resistant microorganisms in the ICU was not shown in a country with relatively low rates of resistant microorganisms. |
| first_indexed | 2024-12-21T11:05:06Z |
| format | Article |
| id | doaj.art-2cfe91dacf9e4e5fa4a715dc17c45c28 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T11:05:06Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-2cfe91dacf9e4e5fa4a715dc17c45c282022-12-21T19:06:15ZengBMCCritical Care1364-85352019-06-012311910.1186/s13054-019-2480-zThe ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre studySophie Buitinck0Rogier Jansen1Saskia Rijkenberg2Jos P. J. Wester3Rob J. Bosman4Nardo J. M. van der Meer5Peter H. J. van der Voort6Department of Intensive Care, OLVG HospitalDepartment of Medical Microbiology, OLVG HospitalDepartment of Intensive Care, OLVG HospitalDepartment of Intensive Care, OLVG HospitalDepartment of Intensive Care, OLVG HospitalTIAS School for Business and SocietyDepartment of Intensive Care, OLVG HospitalAbstract Background The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly acquired antimicrobial resistance of aerobic gram-negative potentially pathogenic bacteria (AGNB) during SDD. Methods In a single-centre observational cohort study over a 21-year period, all consecutive patients, treated with or without SDD, admitted to the ICU were included. The antibiotic regime was unchanged over the study period. Incidence rates for ICU-acquired AGNB’s resistance for third-generation cephalosporins, colistin/polymyxin B, tobramycin/gentamicin or ciprofloxacin were calculated per year. Changes over time were tested by negative binomial regression in a generalized linear model. Results Eighty-six percent of 14,015 patients were treated with SDD. Most cultures were taken from the digestive tract (41.9%) and sputum (21.1%). A total of 20,593 isolates of AGNB were identified. The two most often found bacteria were Escherichia coli (N = 6409) and Pseudomonas (N = 5269). The incidence rate per 1000 patient-day for ICU-acquired resistance to cephalosporins was 2.03, for polymyxin B/colistin 0.51, for tobramycin 2.59 and for ciprofloxacin 2.2. The incidence rates for ICU-acquired resistant microbes per year ranged from 0 to 4.94 per 1000 patient-days, and no significant time-trend in incidence rates were found for any of the antimicrobials. The background prevalence rates of resistant strains measured on admission for cephalosporins, polymyxin B/colistin and ciprofloxacin rose over time with 7.9%, 3.5% and 8.0% respectively. Conclusions During more than 21-year SDD, the incidence rates of resistant microbes at the ICU level did not significantly increase over time but the background resistance rates increased. An overall ecological effect of prolonged application of SDD by counting resistant microorganisms in the ICU was not shown in a country with relatively low rates of resistant microorganisms.http://link.springer.com/article/10.1186/s13054-019-2480-zSelective digestive tract decontaminationSDDResistanceEcological effectCritically ill |
| spellingShingle | Sophie Buitinck Rogier Jansen Saskia Rijkenberg Jos P. J. Wester Rob J. Bosman Nardo J. M. van der Meer Peter H. J. van der Voort The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study Critical Care Selective digestive tract decontamination SDD Resistance Ecological effect Critically ill |
| title | The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study |
| title_full | The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study |
| title_fullStr | The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study |
| title_full_unstemmed | The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study |
| title_short | The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study |
| title_sort | ecological effects of selective decontamination of the digestive tract sdd on antimicrobial resistance a 21 year longitudinal single centre study |
| topic | Selective digestive tract decontamination SDD Resistance Ecological effect Critically ill |
| url | http://link.springer.com/article/10.1186/s13054-019-2480-z |
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