- Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands. [Journal Article]
- PlosPLoS One 2019; 14(6):e0218372
- Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP us…
Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past exposures. The prospective surveillance of intensive care patients aged ≥16 years and ventilated ≥48 hours resulted in the inclusion of 940 primary ventilation periods, comprising 7872 ventilation days. The average VAP incidence density was 10.3/1000 ventilation days. Independent risk factors were age (16-40 years at increased risk: HR 2.42 95% confidence interval 1.07-5.50), COPD (HR 0.19 [0.04-0.78]), current sedation score (higher scores at increased risk), current selective oropharyngeal decontamination (HR 0.19 [0.04-0.91]), jet nebulizer (WCE, decreased risk), intravenous antibiotics for selective decontamination of the digestive tract (ivSDD, WCE, decreased risk), and intravenous antibiotics not for SDD (WCE, decreased risk). The protective effect of ivSDD was afforded for 24 days with a delay of 3 days. For some time-dependent variables, the WCE model was preferable over standard Cox proportional hazard regression. The WCE method can furthermore increase insight into the active time frame and possible delay herein of a time-dependent risk factor.
- The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study. [Journal Article]
- CCCrit Care 2019 Jun 07; 23(1):208
- CONCLUSIONS: 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.
- Clinical Effects of Perioperative Selective Decontamination of the Digestive Tract (SDD) in Cardiac Surgery: A Propensity Score Matched Cohort Analysis. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2019 Apr 20
- CONCLUSIONS: Cardiosurgical patients who receive tobramycin and polymyxin orally preoperatively to reduce the gut endotoxin level do not expose convincing and relevant beneficial effects on clinical outcomes in this retrospective propensity score matching cohort study.
- Antibiotic susceptibility trend before and after long-term use of selective digestive decontamination: a 16 year ecological study. [Journal Article]
- JAJ Antimicrob Chemother 2019 May 07
- CONCLUSIONS: 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.
- [Selective intestinal decontamination in colorectal cancer surgery]. [Journal Article]
- CChirurg 2019; 90(4):326
- Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). [Journal Article]
- BJBr J Surg 2019; 106(4):355-363
- CONCLUSIONS: SDD reduces infectious complications after colorectal cancer resection but did not significantly reduce anastomotic leakage in this trial. Registration number: NCT01740947 (https://www.clinicaltrials.gov).
- Monitoring of tobramycin serum concentrations in selected critically ill patients receiving selective decontamination of the digestive tract: a retrospective evaluation. [Journal Article]
- EJEur J Clin Pharmacol 2019; 75(6):831-836
- CONCLUSIONS: The majority (83.7%) of samples had detectable tobramycin serum concentrations. Monitoring of tobramycin serum concentrations can be considered necessary in patients at risk. However, the current protocol should be optimized to intercept patients more precise.
- Selective decontamination of the digestive tract in critical care: a teenage angst or coming of age issue? [Editorial]
- CCCrit Care 2018 Nov 14; 22(1):296
- Selective decontamination of the digestive tract (SDD) has been with us since the early days of our specialty, and in some ways it marks our progression and maturation. How we have dealt with SDD to …
Selective decontamination of the digestive tract (SDD) has been with us since the early days of our specialty, and in some ways it marks our progression and maturation. How we have dealt with SDD to date ranges from "thorn in our side" to "elephant in the room". With high quality multi-national studies underway, how we deal with these results will mark our final maturation to adulthood as a specialty.
- The Use of Microbiome Restoration Therapeutics to Eliminate Intestinal Colonization With Multidrug-Resistant Organisms. [Journal Article]
- AJAm J Med Sci 2018; 356(5):433-440
- Antibiotic resistance (AR) has been described by the World Health Organization as an increasingly serious threat to global public health. Many mechanisms of AR have become widespread due to global se…
Antibiotic resistance (AR) has been described by the World Health Organization as an increasingly serious threat to global public health. Many mechanisms of AR have become widespread due to global selective pressures such as widespread antibiotic use. The intestinal tract is an important reservoir for many multidrug-resistant organisms (MDROs), and next-generation sequencing has expanded understanding of the resistome, defined as the comprehensive sum of genetic determinants of AR. Intestinal decolonization has been explored as a strategy to eradicate MDROs with selective digestive tract decontamination and probiotics being notable examples with mixed results. This review focuses on fecal microbiota transplantation and the early evidence supporting its efficacy in decolonizing MDROs and potential mechanisms of action to reduce AR genes. Current evidence suggests that fecal microbiota transplantation may have promise in restoring healthy microbial diversity and reducing AR, and clinical trials are underway to better characterize its safety and efficacy.
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- Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial. [Randomized Controlled Trial]
- JAMAJAMA 2018 11 27; 320(20):2087-2098
- CONCLUSIONS: Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.