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Selective decontamination and antibiotic resistance in ICUs

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Abstract

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.

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Abbreviations

CRE:

carbapenem-resistant Enterobacteriaceae

ESBL:

extended-spectrum beta-lactamase

GNB:

Gram-negative bacteria

HRMO:

highly resistant microorganisms

MDR-GNB:

multidrug-resistant Gram-negative bacteria

MRSA:

methicillin-resistant Staphylococcus aureus

RCT:

randomized controlled trial

SDD:

selective digestive decontamination

SOD:

selective oropharyngeal decontamination

VRE:

vancomycin-resistant enterococci

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Acknowledgements

MJMB has received support from the Innovative Medicines Initiative Joint Undertaking under Combatting Bacterial Resistance in Europe (COMBACTE) grant agreement number 115523, resources for which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies in kind contribution. MJMB and NLP are supported by funding from the European Community’s Seventh Framework Programme for involvement in ‘R-GNOSIS, Resistance in Gram-negative Organisms Studying Intervention Strategies’ (FP7/2007–2013, grant agreement number 282512).

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  1. University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands

    Nienke L. Plantinga & Marc JM Bonten

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  1. Nienke L. Plantinga
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Correspondence to Nienke L. Plantinga.

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The authors declare that they have no competing interests.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Plantinga, N.L., Bonten, M.J. Selective decontamination and antibiotic resistance in ICUs. Crit Care 19, 259 (2015). https://doi.org/10.1186/s13054-015-0967-9

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