title: Use of selective digestive tract decontamination in European intensive cares: the ifs and whys.
abstract: BACKGROUND
  Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multidrug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ERIC), in order to investigate the number of ICUs using SDD and the factors that prevented the use of SDD.
  
  
  METHODS
  One invitation to the electronic survey was sent to each ERIC unit. The survey focused on department characteristics (intensive care type, local resistance levels), local treatment modalities (antibiotic stewardship) and doctors' opinions (collaborative issues concerning SDD). All ICU's in countries participating in the European Centre for Disease Prevention and Control resistance surveillance program were analysed.
  
  
  RESULTS
  Seventeen percent of the ICUs registered in the ERIC database used SDD prophylaxis. Most of these ICUs were located in the Netherlands or Germany. ICUs using SDD were four times more likely to use antibiotic stewardship. Also larger ICUs were more likely to use SDD. On the contrary, resistance to antibiotics was not related to the use of SDD. Also the doctor's opinion that SDD is proven in cluster-randomized trials was not a determinant for not using SDD.
  
  
  CONCLUSIONS
  SDD is used in a minority of the European ICUs registered in the ERIC database. Larger ICUs and ICUs with a prudent antibiotic policy were more likely to use SDD. Neither antibiotic resistance nor the cluster randomized study design were determinants of the non-use of SDD.
authors.affiliation: Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands - d.reismiranda@erasmusmc.nl.
authors.forename: D
authors.initials: D
authors.lastname: Reis Miranda
authors.forename: G
authors.initials: G
authors.lastname: Citerio
authors.forename: A
authors.initials: A
authors.lastname: Perner
authors.forename: G
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: A
authors.initials: A
authors.lastname: Hoes
authors.forename: R
authors.initials: R
authors.lastname: Beale
authors.forename: A M
authors.initials: AM
authors.lastname: De Smet
authors.forename: J
authors.initials: J
authors.lastname: Kesecioglu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data*; D016208:Databases, Factual; D003666:Decontamination / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D005060:Europe; D041981:Gastrointestinal Tract / Q000382:microbiology*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units
chemical_list: D000900:Anti-Bacterial Agents