Intensive Care Unit, Fundación Valle del Lilli, Cali, Colombia.
Intensive Care Med. 2011 Sep;37(9):1458-65. doi: 10.1007/s00134-011-2307-0. Epub 2011 Jul 19.
Despite the evidence, the use of selective decontamination of the digestive tract (SDD) remains controversial, largely because of concerns that it may promote the emergence of antibiotic-resistant strains. The purpose of this study was to evaluate the long-term incidence of carriage of antibiotic-resistant bacteria (ARB), its clinical impact on developing infections and to explore risk factors of acquiring resistance.
This study was conducted in one 18-bed medical-surgical intensive care unit (ICU). All consecutive patients admitted to the ICU who were expected to require tracheal intubation for longer than 48 h were given a 4-day course of intravenous cefotaxime, and enteral polymyxin E, tobramycin, amphotericin B in an oropharyngeal paste and digestive solution. Oropharyngeal and rectal swabs were obtained on admission and once a week. Diagnostic samples were obtained on clinical indication.
During 5 years 1,588 patients were included in the study. The incidence density of ARB was stable: 18.91 carriers per 1,000 patient-days. The incidence of resistant Enterobacteriaceae was stable; the resistance of Pseudomonas aeruginosa to tobramycin, amikacin and ciprofloxacin was strongly reduced; there was an increase of P. aeruginosa resistant to ceftazidime and imipenem, associated with the increase in imipenem consumption; the incidence of other nonfermenter bacilli and oxacillin-resistant Staphylococcus aureus was close to zero. Ninety-seven patients developed 101 infections caused by ARB: 23 pneumonias, 20 bloodstream infections and 58 urinary tract infections. Abdominal surgery was the only risk factor associated with ARB acquisition [risk ratio 1.56 (1.10-2.19)].
Long-term use of SDD is not associated with an increase in acquisition of resistant flora.
尽管有证据表明，选择性消化道去污染（SDD）的使用仍然存在争议，主要是因为担心它可能会促进抗生素耐药菌株的出现。本研究的目的是评估抗生素耐药菌（ARB）携带的长期发生率，其对感染发展的临床影响，并探讨获得耐药性的危险因素。
本研究在一个 18 张床的内科-外科重症监护病房（ICU）进行。所有预计需要气管插管超过 48 小时的 ICU 连续入院患者均接受 4 天疗程的静脉头孢噻肟，以及口服多粘菌素 E、妥布霉素、两性霉素 B 糊剂和消化液。入院时和每周一次采集口咽和直肠拭子。根据临床指征采集诊断样本。
在 5 年期间，共有 1588 名患者纳入研究。ARB 的发病率密度保持稳定：每 1000 患者日 18.91 名携带者。耐药肠杆菌科的发生率保持稳定；铜绿假单胞菌对妥布霉素、阿米卡星和环丙沙星的耐药性显著降低；头孢他啶和亚胺培南耐药铜绿假单胞菌的增加与亚胺培南消耗的增加有关；其他非发酵菌和耐苯唑西林金黄色葡萄球菌的发生率接近零。97 名患者发生 101 例由 ARB 引起的感染：23 例肺炎、20 例血流感染和 58 例尿路感染。腹部手术是唯一与 ARB 获得相关的危险因素[风险比 1.56（1.10-2.19）]。
长期使用 SDD 与获得耐药菌群无关。
