Servicio de Farmacia Hospitalaria, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain.
Departamento de Economía Aplicada III, Facultad de Ciencias Económicas y Empresariales, Universidad del País Vasco UPV/EHU, Bilbao, Spain.
J Antimicrob Chemother. 2019 Aug 1;74(8):2289-2294. doi: 10.1093/jac/dkz186.
The aim of this study was to compare antimicrobial susceptibility rates in a Spanish ICU before and after the introduction of selective digestive decontamination (SDD) and also to compare these with susceptibility data from other Spanish ICUs without SDD.
We performed a retrospective study in the ICU of the University Hospital of Alava, where SDD was implemented in 2002. The SDD protocol consisted of a 2% mixture of gentamicin, colistin and amphotericin B applied on the buccal mucosa and a suspension of the same drugs in the gastrointestinal tract; additionally, for the first 3 days, systemic ceftriaxone was administered. From 1998 to 2013 we analysed the susceptibility rates for 48 antimicrobial/organism combinations. Interrupted time series using a linear dynamic model with SDD as an intervention was used. Data from other ICUs were obtained from the ENVIN-HELICS national registry.
Only amoxicillin/clavulanic acid against Escherichia coli and Proteus mirabilis, and a high concentration of gentamicin against Enterococcus faecalis, resulted in a significant decrease in the susceptibility rate after the implementation of SDD, with a drop of 20%, 27% and 32%, respectively. Compared with other Spanish ICUs without SDD, the susceptibility rate was higher in the ICU of our hospital in most cases. When it was lower, differences were <10%, except for a high concentration of streptomycin against Enterococcus faecium, for which the difference was 19%.
No relevant changes in the overall susceptibility rate after the implementation of SDD were detected. Susceptibility rates were not lower than those in the Spanish ICUs without SDD.
本研究旨在比较引入选择性消化道去污染（SDD）前后西班牙 ICU 中的抗菌药物敏感性率，并与未行 SDD 的其他西班牙 ICU 的药敏数据进行比较。
我们对阿拉瓦大学医院 ICU 进行了回顾性研究，该医院于 2002 年实施 SDD。SDD 方案包括 2%的庆大霉素、黏菌素和两性霉素 B 混合物用于口腔黏膜，以及相同药物的胃肠道混悬液；此外，前 3 天给予系统头孢曲松。1998 年至 2013 年，我们分析了 48 种抗菌药物/病原体组合的药敏率。采用带 SDD 干预的线性动态模型进行中断时间序列分析。其他 ICU 的数据来自 ENVIN-HELICS 国家登记处。
仅在实施 SDD 后，阿莫西林/克拉维酸对大肠埃希菌和奇异变形杆菌，以及高浓度庆大霉素对粪肠球菌的敏感性率显著下降，分别下降 20%、27%和 32%。与未行 SDD 的其他西班牙 ICU 相比，我院 ICU 的药敏率在大多数情况下较高。当药敏率较低时，差异<10%，除了肠球菌对高浓度链霉素的敏感性差异为 19%。
实施 SDD 后，总体药敏率未发生明显变化。药敏率并未低于未行 SDD 的西班牙 ICU。
