Epidemiological impact of prolonged systematic use of topical SDD on bacterial colonization of the tracheobronchial tree and antibiotic resistance

Abstract

Our data suggest that the prolonged use of SDD is associated with dramatic changes in ICU ecology: the incidence of Gram negative colonization is significantly diminished by SDD whereas Gram positive tend to increase. Pseudomonas developed an increasing resistance towards tobramycin one of the components of the SDD formula we used.

Hospital acquired pneumonia

“…Involves systematic use of topical antibiotics applied decontamination to the oropharynx and stomach and intravenous cefotaxime A meta-analysis of trials has shown this to reduce respiratory tract infections and mortality 20 Risk of promoting bacterial resistance 21 Enthusiasm for this measure varies…”

Antibiotic prophylaxis in the era of multidrug-resistant bacteria

“…SDD has been associated with overgrowth and higher prevalence rates of gram-positive bacteria [13][14][15], methicillinresistant Staphylococcus aureus (MRSA) colonization [5,16], and gram-negative bacteria resistant to specific antibiotics such as cephalosporins [17] and aminoglycosides [7]. On the contrary, SDD has been successfully used as an adjunct in controlling an outbreak with multi-resistant Enterobacteriaceae [18] and carbapenem-resistant Klebsiella pneumoniae [19].…”

“…Increased prevalence of colonization with gram positives and MRSA and resistance to cephalosporins during SDD in settings with moderate-high levels of antibiotic resistance [5,[13][14][15][16] 3. Long-term ecological safety demonstrated…”

Reply to “Selective Digestive Tract Decontamination and Spread of Colistin Resistance: Antibiotic Prophylaxis Is Not a Substitute for Hygiene”

“…In some outbreak settings, polymyxin resistance as a consequence of SDD use was not observed (9-11), while in other settings, this did occur (12)(13)(14). Unfortunately, information regarding the occurrence of polymyxin resistance among Enterobacteriaceae or polymyxin susceptibility testing is not provided in numerous studies assessing antimicrobial resistance (including that to polymyxin E) over time under the use of SDD (15)(16)(17)(18)(19).Although concentrations of topical nonabsorbable antibiotics are usually high in the gut (high enough to exceed minimal bactericidal concentrations [15]), colistin might be biologically inactivated by intestinal contents (20) or sucralfate (21), which is often used in ICU patients; therefore, topical antibiotics lack effectiveness, necessitating high oral doses to achieve suitable fecal concentrations (22). In our ICU, sucralfate was avoided, but concentrations of the SDD components in the gut were not measured.…”

“…In some outbreak settings, polymyxin resistance as a consequence of SDD use was not observed (9-11), while in other settings, this did occur (12)(13)(14). Unfortunately, information regarding the occurrence of polymyxin resistance among Enterobacteriaceae or polymyxin susceptibility testing is not provided in numerous studies assessing antimicrobial resistance (including that to polymyxin E) over time under the use of SDD (15)(16)(17)(18)(19).…”