Notice of Retraction and Replacement: Oostdijk et al. Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs: A Randomized Clinical Trial. <i>JAMA</i>. 2014;312(14):1429-1437.

Oostdijk, Evelien; Kesecioğlu, Jozef; Schultz, Marcus J.; Visser, Caroline E.; Jonge, Evert de; Essen, E. H. R. van; Bernards, A.T.; Purmer, Ilse M.; Brimicombe, R.W.; Bergmans, Dennis C. J. J.; Tiel, Frank van; Bosch, Frank H.; Mascini, Ellen M.; Griethuysen, A. J. van; Bindels, Alexander J. G. H.; Jansz, A; Steveninck, Fred A L van; Zwet, W.C. van der; Fijen, J. W.; Thijsen, Steven; Jong, Remko de; Oudbier, Joke; Raben, Adrienne; Vorm, Eric van der; Koeman, Mirelle; Rothbarth, P. H.; Rijkeboer, A. A.; Gruteke, P; Hart, Helga; Peerbooms, P. G. H.; Winsser, Lex J; Elsacker-Niele, Anne-Marie W van; Demmendaal, Kees; Brandenburg, A. H.; Smet, Anne Marie G. A. de; Bonten, Marc J. M.

doi:10.1001/jama.2017.1282

Cited by 39 publications

(55 citation statements)

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“…The findings of the current study differ in several aspects from those obtained in similar studies in Dutch centers. [3][4][5] First, the current study aimed to test decontamination regimens in ICUs with higher prevalence of antibiotic resistance. Indeed, the observed 17.6% unitwide rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae and an overall proportion of 25.5% of ICU-acquired BSIs caused by HRMO are considerably higher than in previous Dutch studies.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the observed 17.6% unitwide rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae and an overall proportion of 25.5% of ICU-acquired BSIs caused by HRMO are considerably higher than in previous Dutch studies. [3][4][5] Decontamination strategies using conventional SDD or SOD regimens may be less effective in this context, especially in areas with high prevalence of resistance to aminoglycosides or colistin among GNB. The unitwide prevalence of colonization with gentamicin-resistant GNB was 8.3% in the rectum and 4.5% in the respiratory tract, which is twice as high as in a previous Dutch study performed between 2004 and 2006, 4 but comparable with the more recent Dutch study performed between 2009 and 2013.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the study findings, an additional post hoc sensitivity analysis was performed to explore potential consequences of not including prophylaxis with third-generation cephalosporins in the SDD regimen and of stopping SDD at the end of mechanical ventilation (rather than at ICU discharge), as had been performed in previous Dutch studies. [3][4][5] In this analysis, all SDD-treated patients with ICU-acquired BSI caused by a pathogen susceptible to third-generation cephalosporins during the first 4 days and/or with ICU-acquired BSI with any pathogen after the end of mechanical ventilation were considered alive for all mortality outcomes, thereby maximizing the potentially missed effects of both changes to previous protocols. As a third post hoc sensitivity analysis, head-tohead comparisons between the randomized intervention groups were performed for all patient-level outcomes.…”

Section: Sample Size and Statistical Analysesmentioning

confidence: 99%

“…In ICUs with low levels of antibiotic resistance, SDD and SOD have been associated with improved patient outcomes, 3,4 with SDD being more efficacious than SOD. 5,6 Currently, SDD and SOD are routinely used in ICUs in the Netherlands, but their use has not been widely adopted in other countries, 7 mainly because of limited efficacy data in settings with higher levels of antibiotic resistance and concern about emergence of antibiotic resistance, although the latter is not supported by meta-analyses. 8 In contrast, chlorhexidine (CHX) mouthwash is widely used in ICU patients and its use has been associated with a lower incidence of ventilator-associated pneumonia, 9,10 with CHX 2% being more efficacious than lower concentrations.…”

mentioning

confidence: 99%

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Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients

Wittekamp

Plantinga

Cooper

et al. 2018

JAMA

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135

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IMPORTANCEThe effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown. OBJECTIVETo determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance. DESIGN, SETTING, AND PARTICIPANTS Randomized trial conducted from December 1, 2013, to May 31, 2017 European ICUs where at least 5% of bloodstream infections are caused by extendedspectrumβ-lactamase-producingEnterobacteriaceae.Patientswithanticipatedmechanicalventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.INTERVENTIONS Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily. MAIN OUTCOMES AND MEASURESThe occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period. RESULTS A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, −0.6% to 1.1%), 0.6% (95% CI, −0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline. CONCLUSIONS AND RELEVANCE Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Sample Size and Statistical Analysesmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients

Wittekamp

Plantinga

Cooper

et al. 2018

JAMA

Self Cite

135

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“…The metanalysis of Oostdijk et al (44) reviewed the current literature comparing selective gastric decontamination, oral decontamination, and their combinations. This metanalysis demonstrated the advantage of selective decontamination versus oral decontamination in reducing the likelihood of ventilatorassociated pneumonia in 28-days follow up (45) .…”

Section: Clinical and Research Consequencesmentioning

confidence: 88%

Prophylactic use of antibiotics in the Intensive Care Unit

Sula¹,

Domi²

2019

JARSS

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Infections during the intensive care treatment present a great continuous challenge to the physicians and to the patients. These infections can significantly increase the morbidity and mortality. One of the major issues to be addressed is the prophylactic use of antibiotics in intensive care units. The importance of infection prevention in critically ill patients is therefore based on its potential to reduce both morbidity and mortality. The relationship between this reduction and the prevention of the development of resistance remains unclear. The infections can also affect treatment costs, hospital stay, and patients' prognosis. This review tends to summarize all the topics regarding the prophylactic use of antibiotics, prevention of infections in intensive care units, and minimizing the resistance.

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Effect of On-Demand vs Routine Nebulization of Acetylcysteine With Salbutamol on Ventilator-Free Days in Intensive Care Unit Patients Receiving Invasive Ventilation

Meenen

Hoeven

Binnekade

et al. 2018

JAMA

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IMPORTANCE It remains uncertain whether nebulization of mucolytics with bronchodilators should be applied for clinical indication or preventively in intensive care unit (ICU) patients receiving invasive ventilation. OBJECTIVETo determine if a strategy that uses nebulization for clinical indication (on-demand) is noninferior to one that uses preventive (routine) nebulization. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial enrolling adult patients expected to need invasive ventilation for more than 24 hours at 7 ICUs in the Netherlands. INTERVENTIONSOn-demand nebulization of acetylcysteine or salbutamol (based on strict clinical indications, n = 471) or routine nebulization of acetylcysteine with salbutamol (every 6 hours until end of invasive ventilation, n = 473). MAIN OUTCOMES AND MEASURESThe primary outcome was the number of ventilator-free days at day 28, with a noninferiority margin for a difference between groups of −0.5 days. Secondary outcomes included length of stay, mortality rates, occurrence of pulmonary complications, and adverse events. RESULTS Nine hundred twenty-two patients (34% women; median age, 66 (interquartile range [IQR], 54-75 years) were enrolled and completed follow-up. At 28 days, patients in the on-demand group had a median 21 (IQR, 0-26) ventilator-free days, and patients in the routine group had a median 20 (IQR, 0-26) ventilator-free days (1-sided 95% CI, −0.00003 to ϱ). There was no significant difference in length of stay or mortality, or in the proportion of patients developing pulmonary complications, between the 2 groups. Adverse events (13.8% vs 29.3%; difference, −15.5% [95% CI, −20.7% to −10.3%]; P < .001) were more frequent with routine nebulization and mainly related to tachyarrhythmia (12.5% vs 25.9%; difference, −13.4% [95% CI, −18.4% to −8.4%]; P < .001) and agitation (0.2% vs 4.3%; difference, −4.1% [95% CI, −5.9% to −2.2%]; P < .001). CONCLUSIONS AND RELEVANCEAmong ICU patients receiving invasive ventilation who were expected to not be extubated within 24 hours, on-demand compared with routine nebulization of acetylcysteine with salbutamol did not result in an inferior number of ventilator-free days. On-demand nebulization may be a reasonable alternative to routine nebulization.

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Notice of Retraction and Replacement: Oostdijk et al. Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs: A Randomized Clinical Trial. JAMA. 2014;312(14):1429-1437.

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Cited by 39 publications

References 1 publication

Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients

Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients

Prophylactic use of antibiotics in the Intensive Care Unit

Effect of On-Demand vs Routine Nebulization of Acetylcysteine With Salbutamol on Ventilator-Free Days in Intensive Care Unit Patients Receiving Invasive Ventilation

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