Department of Intensive Care, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
TIAS School for Business and Society, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
Crit Care. 2019 Jun 7;23(1):208. doi: 10.1186/s13054-019-2480-z.
The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly acquired antimicrobial resistance of aerobic gram-negative potentially pathogenic bacteria (AGNB) during SDD.
In a single-centre observational cohort study over a 21-year period, all consecutive patients, treated with or without SDD, admitted to the ICU were included. The antibiotic regime was unchanged over the study period. Incidence rates for ICU-acquired AGNB's resistance for third-generation cephalosporins, colistin/polymyxin B, tobramycin/gentamicin or ciprofloxacin were calculated per year. Changes over time were tested by negative binomial regression in a generalized linear model.
Eighty-six percent of 14,015 patients were treated with SDD. Most cultures were taken from the digestive tract (41.9%) and sputum (21.1%). A total of 20,593 isolates of AGNB were identified. The two most often found bacteria were Escherichia coli (N = 6409) and Pseudomonas (N = 5269). The incidence rate per 1000 patient-day for ICU-acquired resistance to cephalosporins was 2.03, for polymyxin B/colistin 0.51, for tobramycin 2.59 and for ciprofloxacin 2.2. The incidence rates for ICU-acquired resistant microbes per year ranged from 0 to 4.94 per 1000 patient-days, and no significant time-trend in incidence rates were found for any of the antimicrobials. The background prevalence rates of resistant strains measured on admission for cephalosporins, polymyxin B/colistin and ciprofloxacin rose over time with 7.9%, 3.5% and 8.0% respectively.
During more than 21-year SDD, the incidence rates of resistant microbes at the ICU level did not significantly increase over time but the background resistance rates increased. An overall ecological effect of prolonged application of SDD by counting resistant microorganisms in the ICU was not shown in a country with relatively low rates of resistant microorganisms.
选择性消化道去定植（SDD）对 ICU 水平出现抗微生物药物耐药性的长期生态影响尚不清楚。我们确定了 SDD 期间有氧革兰氏阴性潜在致病细菌（AGNB）新获得的抗微生物药物耐药性的发生率。
在一项为期 21 年的单中心观察性队列研究中，纳入了所有连续接受或未接受 SDD 治疗的 ICU 患者。研究期间抗生素方案保持不变。每年计算第三代头孢菌素、多粘菌素 B/多粘菌素 E、妥布霉素/庆大霉素或环丙沙星的 ICU 获得性 AGNB 耐药率的发生率。通过广义线性模型中的负二项式回归测试随时间的变化。
14015 例患者中有 86%接受了 SDD 治疗。大多数培养物取自消化道（41.9%）和痰液（21.1%）。共鉴定出 20593 株 AGNB。最常见的两种细菌是大肠埃希菌（N=6409）和铜绿假单胞菌（N=5269）。每 1000 个患者日 ICU 获得性头孢菌素耐药率为 2.03，多粘菌素 B/多粘菌素 E 为 0.51，妥布霉素为 2.59，环丙沙星为 2.2。每年 ICU 获得性耐药微生物的发生率范围为 0 至 4.94/1000 患者日，任何一种抗生素的发生率均无明显时间趋势。入院时测量的头孢菌素、多粘菌素 B/多粘菌素 E 和环丙沙星的耐药菌株背景流行率随时间推移分别上升了 7.9%、3.5%和 8.0%。
在超过 21 年的 SDD 期间，ICU 水平的耐药微生物的发生率并没有随时间显著增加，但背景耐药率增加。在耐药微生物相对较少的国家，通过在 ICU 中计数耐药微生物来计算 SDD 的长期应用对总体生态的影响并不明显。
