Colistin and tobramycin resistance during long term use of selective decontamination strategies in the intensive care unit: a post-hoc analysis (Critical Care)

IntroductionSelective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) have been shown to improve intensive care unit (ICU) patients’ outcomes. The aim of this study was to determine the effects of long-term use of SDD and SOD on colistin and tobramycin resistance among gram-negative bacteria. Methods: We performed a post-hoc analysis of two consecutive multicentre cluster randomised trials with crossover of interventions. SDD and SOD were alternately but continuously used during seven years in five Dutch ICUs participating in two consecutive cluster randomised trials. In both trials, to measure colistin and tobramycin resistance among gram-negative bacteria, rectal and respiratory samples were obtained monthly from all patients present in the ICU. Results: The prevalence of tobramycin resistance in respiratory and rectal samples decreased significantly during long term use of SOD and SDD. (rectal samples risk ratio (RR) 0.35 (0.23 to 0.53); respiratory samples RR 0.48 (0.32 to 0.73), SDD compared to standard care). Colistin resistance in rectal and respiratory samples did not change. (rectal samples RR 0.63 (0.29 to 1.38); respiratory samples RR 1.26 (0.35 to 4.57), SDD compared to standard care). Conclusions: In this study in a setting with low antimicrobial resistance rates the prevalence of resistance against colistin and tobramycin among gram-negative isolates did not increase during a mean of 7 years of SDD or SOD use.