Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

Smet, Anne Marie G. A. de; Kluytmans, Jan; Blok, Hetty E. M.; Mascini, Ellen M.; Benus, Robin F. J.; Bernards, A.T.; Kuijper, Ed J.; Hall, Maurine A. Leverstein–van; Jansz, A; Jongh, B. M. De; Asselt, G. J. van; Frenay, Ine; Thijsen, Steven; Conijn, Simon N. M.; Kaan, J. A.; Arends, Jan P.; Sturm, Patrick; Bootsma, Martin; Bonten, Marc J. M.

doi:10.1016/s1473-3099(11)70035-4

Cited by 169 publications

(110 citation statements)

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“…In another follow-up study (141), SOD and SDD were also associated with decreased rates of bacteremia and colonization of the respiratory tract with antibiotic-resistant Gram-negative bacteria among patients admitted to the ICU for greater than 3 days. That study included 47 episodes of acquired BSI that were caused by highly resistant organisms.…”

Section: Selective Digestive or Oropharyngeal Decontaminationmentioning

confidence: 87%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Section: Selective Digestive or Oropharyngeal Decontaminationmentioning

confidence: 87%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…It is clear from these results that, although clinicians' knowledge of the evidence base could be improved, fear of driving antibiotic resistance is a major limiting factor that needs to be more clearly understood before clinicians will implement this regimen [7][8][9]. It is fascinating to reflect that an evidence base suggesting effectiveness in 36 RCT amassed over a 30 year period [1][2][3][4][5][6] is not compelling enough to overcome a perceived risk of driving antibiotic resistance that, to date, has not been upheld in the existing literature [7][8][9]. The interview topic guide was based on a theoretical framework of clinical behaviour [14] which ensured good coverage of potential barriers and facilitators to SDD adoption.…”

Section: Discussionmentioning

confidence: 99%

“…SDD involves the prophylactic application of topical non-absorbable antibiotics to the oropharynx and stomach with a short course of intravenous antibiotics. Despite much interest over many years and a large evidence base (36 randomised controlled studies) suggesting efficacy in reducing rates of HAIs and increasing survival [1][2][3][4][5][6][7][8][9] SDD has not been widely adopted into intensive care practice worldwide. SDD continues to be a controversial subject, and seems to receive limited support from clinicians [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…The content of each of the domains is described in Table 1. The controversial nature of SDD and the uncertainty about its evidence base [1][2][3][4][5][6][7][8][9]15,16] suggests that clinicians both within and between different clinical specialities and professional groups may hold opposing views. This study therefore applied Delphi methodology to systematically assess agreement/disagreement with SDD within ICU healthcare professionals.…”

Section: Introductionmentioning

confidence: 99%

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The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study

Duncan

Cuthbertson

Prior

et al. 2014

Journal of Critical Care

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link Materials and MethodsParticipants were health professionals with 'decisional authority' for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery and further SDD research were explored. Directed content analysis of interview data identified sub-themes which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored.Results 141 participants provided interview data. Fifty-six sub-themes were identified; 46 were common across regions. Beliefs about consequences was the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as worry, anxiety and fear when discussing potential antibiotic resistance associated with SDD. ConclusionsWe identified salient beliefs, barriers and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty and concern that SDD evokes.

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“…Infection prevention measures relate to accountability, education, surveillance of nosocomial infection, hand hygiene, and prevention of respiratory, central catheter-related, surgical site, and urinary tract infections. 17 Although the literature indicates that the incidence of antimicrobial resistance does not change appreciably with current selective digestive decontamination regimens, [18][19][20] the use of oral chlorhexidine gluconate is relatively easy, decreases the risk of nosocomial infection, and reduces potential concern over promotion of antimicrobial resistance by selective digestive decontamination regimens. …”

Section: Infection Preventionmentioning

confidence: 99%

Implications of the New International Sepsis Guidelines for Nursing Care

Kleinpell¹,

Aitken²,

Schorr³

2013

American Journal of Critical Care

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Sepsis is a serious worldwide health care condition that is associated with high mortality rates, despite improvements in the ability to manage infection. New guidelines for the management of sepsis were recently released that advocate for implementation of care based on evidence-based practice for both adult and pediatric patients. Critical care nurses are directly involved in the assessment of patients at risk for developing sepsis and in the treatment of patients with sepsis and can, therefore, affect outcomes for critically ill patients. Nurses' knowledge of the recommendations in the new guidelines can help to ensure that patients with sepsis receive therapies that are based on the latest scientific evidence. This article presents an overview of new evidence-based recommendations for the treatment of adult patients with sepsis, highlighting the role of critical care nurses.

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Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

Cited by 169 publications

References 14 publications

Decolonization in Prevention of Health Care-Associated Infections

Decolonization in Prevention of Health Care-Associated Infections

The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study

Implications of the New International Sepsis Guidelines for Nursing Care

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