Autor(es):
Plantinga, N.L. ; Wittekamp, B.H.J. ; Brun-Buisson, C. ; Bonten, M.J.M. ; Cooper, B.S. ; Coll, P. ; Lopez-Contreras, J. ; Mancebo, J. ; Wise, M.P. ; Morgan, M.P.G. ; Depuydt, P. ; Boelens, J. ; Dugernier, T. ; Verbelen, V. ; Jorens, P.G. ; Verbrugghe, W. ; Malhotra-Kumar, S. ; Damas, P. ; Meex, C. ; Leleu, K. ; van den Abeele, A.M. ; Esteves, F. ; de Matos, A.F.G.P. ; Torres, A. ; Méndez, S.F. ; Gomez, A.V. ; Tomic, V. ; Sifrer, F. ; Tello, E.V. ; Ramos, J.R. ; Aragao, Irene ; Santos, C. ; Sperning, R.H.M. ; Coppadoro, P. ; Nardi, G.
Data: 2020
Identificador Persistente: http://hdl.handle.net/10400.16/2558
Origem: Repositório Científico da Unidade Local de Saúde de Santo António (ULSSA)
Assunto(s): Antibiotic resistance; Colonization; Decontamination; ESBL; Gram-negative bacteria; ICU; SDD
Descrição
Objectives: The aim was to quantify the effects of selective digestive tract decontamination (SDD) consisting of a mouth paste and gastro-enteral suspension, selective oropharyngeal decontamination with a mouth paste (SOD) and 1-2% chlorhexidine (CHX) mouthwash on eradication and acquisition of carriage of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) and carbapenem-resistant Gram-negative bacteria (CR-GNB) in Intensive Care Unit (ICU) patients. Methods: This was a nested cohort study within a cluster-randomized cross-over trial in six European countries and 13 ICUs with 8665 patients. Eradication and acquisition during ICU stay of 3GCR-E and CR-GNB were investigated separately in the rectum and respiratory tract for the three interventions and compared with standard care (SC) using Cox-regression competing events analyses. Results: Adjusted cause specific hazard ratios (CSHR) for eradication of rectal carriage for SDD were 1.76 (95% CI 1.31-2.36) for 3GCR-E and 3.17 (95% CI 1.60-6.29) for CR-GNB compared with SC. For the respiratory tract, adjusted CSHR for eradication of 3GCR-E were 1.47 (0.98-2.20) for SDD and 1.38 (0.92-2.06) for SOD compared with SC, and for eradication of CR-GNB these were 0.77 (0.41- 1.45) for SDD and 0.81 (0.44-1.51) for SOD, compared with SC. Adjusted CSHRs for acquisition of rectal carriage during SDD (compared with SC) were 0.51 (0.40-0.64) for 3GCR-E and of 0.56 (0.40-0.78) for CR-GNB. Adjusted CSHRs for acquiring respiratory tract carriage with 3GCR-E compared with SC were 0.38 (0.28-0.50) for SDD and 0.55 (0.42-0.71) for SOD, and for CR-GNB 0.46 (0.33-0.64) during SDD and 0.60 (0.44-0.81) during SOD, respectively. SOD was not associated with eradication or acquisition of 3GCR-E and CR-GNB in the rectum. Conclusions: Among mechanically ventilated ICU patients, SDD was associated with more eradication and less acquisition of 3GCR-E and CR-GNB in the rectum than SC. SDD and SOD were associated with less acquisition of both 3GCR-E and CR-GNB than SC in the respiratory tract.
