Decreased duration of intravenous cephalosporins in intensive care unit patients with selective digestive decontaminatio
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ORIGINAL ARTICLE
Decreased duration of intravenous cephalosporins in intensive care unit patients with selective digestive decontamination: a retrospective before-and-after study Calypso Mathieu 1 & Roberta Abbate 1,2 & Zoe Meresse 1 & Emmanuelle Hammad 1 & Gary Duclos 1 & François Antonini 1 & Nadim Cassir 3 & Jeroen Schouten 4 & Laurent Zieleskiewicz 1 & Marc Leone 1,3,5 Received: 11 February 2020 / Accepted: 25 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Selective digestive decontamination (SDD) reduces the rate of infection and improves the outcomes of patients admitted to an intensive care unit (ICU). A risk associated with its use is the development of multi-drug-resistant organisms. We hypothesized that a 1-day reduction in systemic antimicrobial exposure in the SDD regimen would not affect the outcomes of our patients. In this before-and-after study design, 199 patients and 248 patients were included in a 3-day SDD group and a 2-day SDD group, respectively. The rates of hospital-acquired pneumonia and ICU infections were similar in both groups. The rates of bloodstream infection and bacteriuria were significantly lower in the 2-day SDD group than in the 3-day SDD group. Compared with the patients in the 3-day group, the patients in the 2-day SDD group received fewer antibiotics and less exposure to mechanical ventilation, and they used fewer ICU resources. The rates of ICU mortality and 28-day mortality were similar in both groups. The incidence of multi-drug-resistant organisms was similar in both groups. Within the limitations inherent to our study design, reducing the exposure of prophylactic systemic antibiotics in the SDD setting from 3 days to 2 days was not associated with impaired outcomes. Future randomized controlled trials should be conducted to test this hypothesis and investigate the effects on the development of multi-drug resistant organisms. Keywords Infection . Selective . Decontamination . Prophylaxis . Antibiotic
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-03966-w) contains supplementary material, which is available to authorized users. * Marc Leone [email protected] 1
Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d’anesthésie et de réanimation, Marseille, France
2
Department of Anesthesiology, University of Naples Federico II, Naples, Italy
3
MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France
4
Department of Intensive Care, Radboudumc, Netherlands
5
Chemin des Bourrely, Service d’anesthésie et de réanimation, 13015 Marseille, France
Infection is a major cause of morbidity and mortality in intensive care units (ICU) [1]. The most common ICU-acquired infections are due to hospital-associated pneumonia (HAP), which were reported to be 15 to 18 episodes per 1000 ventilator days in Europe and 12% in French healthcare Networks [2, 3]. In selective digestive decontamination (SDD), an enteral and orop
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