[Selective decontamination of the digestive tract: repercussions on microbiology laboratory workload and costs, and antibiotic resistance trends].
BACKGROUND
This study determines the workload and cost of implementing selective digestive decontamination in the microbiology laboratory, and reports the impact on microbial flora and bacterial resistance trends in the intensive care unit (ICU).


METHODS
The total microbiological workload and cost were quantified, as well as the part charged to the petitioning service, in the year before and the year after introducing the procedure. Changes in microbial flora were evaluated and bacterial resistance trends were analyzed over 12 years in 21 sentinel antimicrobial/microorganism combinations.


RESULTS
The workload ascribed to the ICU increased by 10% and cost increased by 1.8% in the period after introduction of the procedure (non-significant differences). The increased workload resulting from epidemiological surveillance cultures was compensated by significant reductions in quantitative endotracheal aspirate cultures, blood cultures, exudate cultures, identification tests with antibiograms, and serologies. The procedure has been associated with a significant decrease in Acinetobacter isolates and a significant increase in Enterococcus. Three significant trends of increased resistance were detected, all of them in Pseudomonas aeruginosa (imipenem, tobramycin, and ciprofloxacin).


CONCLUSIONS
In our hospital, implementation of selective digestive decontamination did not cause a significant increase in the workload or costs in the microbiology laboratory. Selective digestive decontamination was associated with a significant decrease in Acinetobacter, an increase in Enterococcus, and higher resistance to imipenem, tobramycin and ciprofloxacin in P. aeruginosa.
García-San Vicente
Blanca
B
Servicio de Laboratorio, Hospital Santiago Apóstol, Osakidetza-Servicio Vasco de Salud, Vitoria, Alava, Spain.
Canut
Andrés
A
Labora
Alicia
A
Otazua
Maritxu
M
Corral
Esther
E
D000666:Amphotericin B / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001420:Bacteria, Aerobic / Q000187:drug effects* / Q000302:isolation & purification; D001431:Bacteriological Techniques / Q000191:economics / Q000706:statistics & numerical data; D002443:Ceftriaxone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003091:Colistin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D003666:Decontamination / Q000191:economics / Q000379:methods*; D025141:Drug Resistance, Fungal; D004352:Drug Resistance, Microbial; D005658:Fungi / Q000187:drug effects* / Q000302:isolation & purification; D041981:Gastrointestinal Tract / Q000382:microbiology*; D005839:Gentamicins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D017721:Hospital Costs; D006769:Hospitals, General / Q000191:economics; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007755:Laboratories, Hospital / Q000191:economics; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013030:Spain; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data*
D000890:Anti-Infective Agents; D005839:Gentamicins; D002443:Ceftriaxone; D000666:Amphotericin B; D003091:Colistin