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Table 1 Effects of selective decontamination in ICUs where multidrug-resistant Gram-negative bacteria were endemic

From: Selective decontamination and antibiotic resistance in ICUs

Author, year, country Design (duration), setting MDR species; population Intervention – targeted/universal; study groups Treatment efficacy Resistance to SDD Reported conclusion
Brun-Buisson and colleagues, 1989, France [22] Prospective observational study (10 weeks) followed by RCT (8 weeks), medical ICU MDR-E; ICU LOS >2 days and admission severity of illness score >2 (n = 210) Universal: SDD = neomycin, polymyxin E and nalidic acid (no IV); (1) no SDD (observation, n = 124), (2) no SDD (RCT, n = 50), (3) SDD (RCT, n = 36) ICU-acquired colonization with MDR-E: 19.6 % vs. 10 % vs. 2.9 % (P < 0.01 for 1 vs. 3); infection/colonization clinical site with MDR-E: 9 % vs. 6 % vs. 0 % Rectal colonization with species resistant to SDD: 32 % vs. 58 % (P = 0.02, 2 vs. 3) ‘… intestinal decontamination can be helpful to control outbreaks of multiresistant gram-negative bacilli, especially due to Klebsiella species, in the intensive care setting.’
Taylor and Oppenheim, 1991, USA [23] Before–after study (2 + 2 months), multidisciplinary ICU ESBL-KA; ICU LOS >48 hours (n = 33) Universal: SDD = colistin, tobramycin and amphotericin (no IV); (1) no SDD (2 months, n = 15), (2) SDD (2 months, n = 18) Colonization/infection ESBL-KA: 26.7 % vs. 0% ‘No gram-negative aerobes resistant to the SDD drugs or ceftazidime emerged during the SDD regimen’ ‘SDD appears to be a useful tool for eradicating outbreaks due to Gram-negative aerobic bacilli.’
Decré and colleagues, 1998, France [24] Observational study (12 months), infectious disease ICU ESBL-KP; (1) all patients admitted to ICU, (2) colonized and/or infected patients (n = 404) Universal vs. targeted: SDD = erythromycin and polymyxin E (no IV); (1) universal SDD (7 months, n = 239), (2) targeted SDD (5 months, n = 165) ICU-acquired colonization/infection with ESBL-K: 10.0 % vs. 9.1 %; ICU-acquired infection with ESBL-KP: 7.5 % vs. 3.6 % Not reported ’… prophylactic SDD failed to significantly reduce the incidence of acquisition of ESBL-producing strains.’
Agusti and colleagues, 2002, Spain [25] Before–after study (2 + 2 months with 5 months between), ICU Acinetobacter baumannii; patients with A. baumannii intestinal carriage, expected ICU LOS >5 days (n = 54) Targeted: SDD = polymyxin E and tobramycin (no IV); (1) no SDD (n = 33), (2) SDD (n = 21) A. baumanni colonization at ICU discharge: pharyngeal 78 % vs. 38 % (P = 0.03), rectal 91 % vs. 48 % (P < 0.001); A. baumanni in clinical samples: 81% vs. 45.5 % (P = 0.05) ‘No resistance to colistin developed during the study’ ‘… SDD may be beneficial, decreasing the intestinal reservoir in ICU patients with A. baumannii colonization […]. … if SDD is used in the setting of an A. baumannii outbreak, decontamination should not be restricted to the digestive tract, but applied also to the skin …’
Lubbert and colleagues, 2013, Germany [26] Retrospective cohort (28 months), surgical ICU KPC-2-KP; patients colonized/infected with KPC-2-KP (n = 90) Targeted: SDD = colistin and gentamicin (no IV); (1) SDD (n = 14), six received concomitant IV antibiotic therapy for KPC-2-KP infection, (2) no SDD (n = 76), 22 received concomitant IV antibiotic therapy for KPC-2-KP infection In-hospital mortality: 36 % vs. 45 %; decolonization (at day 21): 43 % vs. 17 % Colistin: two patients receiving SDD (both also received colistin IV); gentamicin: five patients receiving SDD (three also received gentamicin IV) “… SDD with gentamicin and colistin contributed to decolonization of KPC-2-KP in 6 of 14 cases (43 %) but revealed a substantial risk of rapid induction of secondary bacterial resistance to colistin and gentamicin.’
  1. ESBL-KA, extended spectrum beta-lactamase-producing Klebsiella aerogenes; ESBL-KP, extended spectrum beta-lactamase-producing Klebsiella pneumonia; IV, intravenous antibiotics; KPC-2-KP, Klebsiella pneumoniae carbapenemase-2-producing Klebsiella pneumonia; LOS, length of stay; MDR, multidrug-resistant; MDR-E, multidrug-resistant Enterobacteriaceae; RCT, randomized controlled trial; SDD, selective digestive decontamination.