Giving critically ill patients antibiotics as a preventive measure significantly reduces the risk of infection with highly resistant microorganisms, according to the largest prospective study of topical preventive antibiotics in intensive care unit (ICU) patients, published Online First in The Lancet Infectious Diseases.
Increasing numbers of ICU patients develop respiratory tract infections, which are associated with high mortality, especially when they are caused by highly resistant microorganisms. Reductions in the rates of respiratory tract infections has been achieved with antibiotic treatment regimens that remove potentially harmful bacteria from the mouth, stomach, and gut, such as selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD). But the use of SDD and SOD has not been widely adopted in ICUs because their effect on resistance to the antimicrobials used is not clear.
To provide more evidence, a team from the Netherlands led by Anne Marie de Smet from University Medical Center Utrecht conducted a randomised trial to compare the effectiveness of antibiotic regimens involving SDD (1868 patients) and SOD (1758 patients) with standard care (1837 patients) for the prevention of bacteraemia (when bacteria gets into the bloodstream) and respiratory tract colonisation with highly resistant microorganisms in 13 Dutch ICUs with low rates of antibiotic resistance. Patients who were expected to need a ventilator for at least 2 days or were expected to be in ICU for at least 3 days were included.
Patients treated with SDD were 59% less likely to develop bacteraemia with highly resistant microorganisms than patients given standard care and 63% less likely than patients receiving SOD.
Additionally, compared with standard treatment, SDD reduced the risk of respiratory tract colonisation with highly resistant microorganisms by 38% and SOD reduced this risk by 32%.
The authors say: "The beneficial effects of SDD and SOD on outcomes, together with the favourable results for infection and colonisation with antibiotic-resistant pathogens reported in this study, justify the extended use of these interventions in settings with low rates of antibiotic resistance."
The authors conclude by calling for further research into whether resistance to antibiotics could develop in the longer term and in settings with higher rates of antibiotic resistance.
In a Comment, Jean-Louis Vincent and Frédérique Jacobs from Erasme Hospital, Brussels, Belgium say: "These interesting findings are mitigated by a lack of effect on problematic organisms, the study setting, and the length of observation. We believe that the data...will not convince the world to use SDD or SOD."
Dr Anne Marie de Smet, University Medical Center Utrecht, the Netherlands. T) +31 20 599 3007 E) amga.desmet@gmail.com
Professor Jean-Louis Vincent, Erasme Hospital, Brussels, Belgium. T) +32 475 77 19 03 (mobile) E) jlvincen@ulb.ac.be
Journal
The Lancet Infectious Diseases