Decreased duration of intravenous cephalosporins in intensive care unit patients with selective digestive decontamination: a retrospective before-and-after study

• Published in: European journal of clinical microbiology & infectious diseases Vol. 39; no. 11; pp. 2115 - 2120
• Main Authors: Mathieu, Calypso, Abbate, Roberta, Meresse, Zoe, Hammad, Emmanuelle, Duclos, Gary, Antonini, François, Cassir, Nadim, Schouten, Jeroen, Zieleskiewicz, Laurent, Leone, Marc
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2020; Springer Verlag
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Bacteremia - etiology; Biomedical and Life Sciences; Biomedicine; Cephalosporins - administration & dosage; Cephalosporins - therapeutic use; Drug Administration Schedule; Female; France; Gastrointestinal Tract - microbiology; Hospitals, University; Humans; Infusions, Intravenous; Intensive Care Units; Internal Medicine; Life Sciences; Male; Medical Microbiology; Original; Original Article; Retrospective Studies; France; Infection; Antibiotic; Decontamination; Selective; Prophylaxis
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-020-03966-w

Selective digestive decontamination (SDD) reduces the rate of infection and improves the outcomes of patients admitted to an intensive care unit (ICU). A risk associated with its use is the development of multi-drug-resistant organisms. We hypothesized that a 1-day reduction in systemic antimicrobial exposure in the SDD regimen would not affect the outcomes of our patients. In this before-and-after study design, 199 patients and 248 patients were included in a 3-day SDD group and a 2-day SDD group, respectively. The rates of hospital-acquired pneumonia and ICU infections were similar in both groups. The rates of bloodstream infection and bacteriuria were significantly lower in the 2-day SDD group than in the 3-day SDD group. Compared with the patients in the 3-day group, the patients in the 2-day SDD group received fewer antibiotics and less exposure to mechanical ventilation, and they used fewer ICU resources. The rates of ICU mortality and 28-day mortality were similar in both groups. The incidence of multi-drug-resistant organisms was similar in both groups. Within the limitations inherent to our study design, reducing the exposure of prophylactic systemic antibiotics in the SDD setting from 3 days to 2 days was not associated with impaired outcomes. Future randomized controlled trials should be conducted to test this hypothesis and investigate the effects on the development of multi-drug resistant organisms.