title: Effects of long-term routine use of selective digestive decontamination on antimicrobial resistance.
abstract: OBJECTIVE
  To assess the distribution of bacterial species and antimicrobial resistance in an ICU during long-term use of selective digestive decontamination (SDD) in the context of national reference data.
  
  
  METHODS
  Five-year prospective observational study in a 24-bed interdisciplinary surgical ICU of a university hospital (study ICU) participating in the project "Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units" (SARI; reference ICUs).
  
  
  METHODS
  Resistance data were obtained from all patients; patients intubated for at least 2 days received SDD (colistin, tobramycin, amphotericin B).
  
  
  METHODS
  SDD was performed in 1,913 of 7,270 patients. Antimicrobial resistance was examined in 4,597 (study ICU) and 46,346 (reference ICUs) isolates.
  
  
  RESULTS
  Methicillin-resistant Staphylococcus aureus (MRSA) remained stable (2.76 and 2.58 isolates/1000 patient days) in the study ICU; this was below the German average (4.26 isolates/1000 patient days). Aminoglycoside- and betalactam-resistant Gram-negative rods did not increase during SDD use. Aminoglycoside resistance of Pseudomonas aeruginosa was 50% below the mean value of SARI (0.24 vs. 0.52 isolates/1,000 patient days). The relative frequency of enterococci and coagulase-negative staphylococci (CNS) was higher than in the SARI ICUs (23.2% vs. 17.3%, and 25.0% vs. 20.6%, respectively).
  
  
  CONCLUSIONS
  Routine 5-year-use of SDD was not associated with increased antimicrobial resistance in our ICU with low baseline resistance rates. Vigorous surveillance and control measures to search and destroy MRSA were considered a mandatory component of the SDD program. The relative increase in enterococci and CNS is of concern requiring further investigation.
authors.affiliation: Tübingen University Hospital, Department for Anesthesiology and Intensive Care Medicine, Tübingen, Germany. alexandra.heininger@med.uni-tuebingen.de
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heininger
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Meyer
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Matthias
authors.initials: M
authors.lastname: Marschal
authors.forename: Klaus
authors.initials: K
authors.lastname: Unertl
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Krueger
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy; D004064:Digestive System / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D010356:Patient Isolation; D011159:Population Surveillance; D011446:Prospective Studies; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000666:Amphotericin B; D014031:Tobramycin; D003091:Colistin