Abstract
Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.
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Abbreviations
- CRE:
-
carbapenem-resistant Enterobacteriaceae
- ESBL:
-
extended-spectrum beta-lactamase
- GNB:
-
Gram-negative bacteria
- HRMO:
-
highly resistant microorganisms
- MDR-GNB:
-
multidrug-resistant Gram-negative bacteria
- MRSA:
-
methicillin-resistant Staphylococcus aureus
- RCT:
-
randomized controlled trial
- SDD:
-
selective digestive decontamination
- SOD:
-
selective oropharyngeal decontamination
- VRE:
-
vancomycin-resistant enterococci
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Acknowledgements
MJMB has received support from the Innovative Medicines Initiative Joint Undertaking under Combatting Bacterial Resistance in Europe (COMBACTE) grant agreement number 115523, resources for which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and the European Federation of Pharmaceutical Industries and Associations (EFPIA) companies in kind contribution. MJMB and NLP are supported by funding from the European Community’s Seventh Framework Programme for involvement in ‘R-GNOSIS, Resistance in Gram-negative Organisms Studying Intervention Strategies’ (FP7/2007–2013, grant agreement number 282512).
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Plantinga, N.L., Bonten, M.J. Selective decontamination and antibiotic resistance in ICUs. Crit Care 19, 259 (2015). https://doi.org/10.1186/s13054-015-0967-9
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DOI: https://doi.org/10.1186/s13054-015-0967-9