title: Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients.
abstract: OBJECTIVE
  To determine whether selective digestive decontamination (SDD) had some negative impact on the bacterial resistance observed in strains isolated from samples from patients receiving nonabsorbable antibiotics and cefazolin.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Intensive care unit of a university tertiary-care hospital.
  
  
  METHODS
  Over a 6-yr period, 360 multiple trauma patients (case patients) submitted to SDD were compared with 360 patients not receiving SDD (controls).
  
  
  METHODS
  SDD consisted of polymyxin E, gentamicin, and amphotericin B and was applied on the buccal mucosa and provided in the nares and the stomach. For the first 3 days, systemic cefazolin (1 g three times a day) was provided. Resistance analysis was performed in case patients and controls on samples collected at predetermined intervals.
  
  
  RESULTS
  SDD was used in a small subset of patients admitted to the intensive care unit (360 of 5987 over the 6-yr study period). A relative overgrowth of gram-positive cocci was observed. Methicillin resistance of Staphylococcus epidermidis was increased (SDD 76%, controls 63%, p <.05) but not that of Staphylococcus aureus (SDD 20%, controls 18%). Resistance of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter to beta-lactamines and aminoglycosides was the same in SDD patients and controls.
  
  
  CONCLUSIONS
  When used in a small subset of patients who have been shown to derive benefit from it (patients who have experienced multiple trauma), SDD has a moderate impact on microbial ecology. However, surveillance cultures are indispensable because the absence of resistance to SDD antibiotics determines the long-term safety of the SDD prophylaxis.
authors.affiliation: Intensive Care Unit and Trsuma Center, Hospital Nord, Marseilles University Hospital System, Marseilles School of Medicine, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.forename: Jacques
authors.initials: J
authors.lastname: Albanese
authors.forename: François
authors.initials: F
authors.lastname: Antonini
authors.forename: Annie
authors.initials: A
authors.lastname: Nguyen-Michel
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
mesh_terms: D018806:APACHE; D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D003091:Colistin / Q000008:administration & dosage / Q000494:pharmacology; D003428:Cross Infection / Q000150:complications / Q000382:microbiology* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D005260:Female; D005602:France; D005839:Gentamicins / Q000008:administration & dosage / Q000494:pharmacology; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000502:physiology; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000502:physiology; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D013212:Staphylococcus epidermidis / Q000187:drug effects* / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000666:Amphotericin B; D003091:Colistin