Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients.
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.
Leone
Marc
M
Intensive Care Unit and Trsuma Center, Hospital Nord, Marseilles University Hospital System, Marseilles School of Medicine, France.
Albanese
Jacques
J
Antonini
François
F
Nguyen-Michel
Annie
A
Martin
Claude
C
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
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000666:Amphotericin B; D003091:Colistin