Selective Decontamination of the Digestive tract in a mixed ICU in a

University tertiary-care hospital: Initial 6 months impact

1University Hospital of Gran Canaria Dr Negrín, Intensive Care Unit, Las Palmas de Gran Canaria, Spain, 2University Hospital of Gran Canaria Dr Negrín, Pharmacy Department, Las Palmas de Gran Canaria, Spain, 3University Hospital of Gran Canaria Dr Negrín, Microbiology Department, Las Palmas de Gran Canaria, Spain, 4Las Palmas de Gran Canaria University, Mathematics and Informatics Department, Las Palmas de Gran Canaria, Spain

Intensive Care Unit, 1Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain

C. Sánchez Ramírez1, M. Cabrera Santana1, S. Hípola Escalada1, M.A. Hernández Viera1, N. Sangil Monroy2, A. Bordes Benitez3, J.J. Díaz Díaz1, J.L. Romero luján1, V. Peña Morant1, P. Saavedra Santana4, S. Ruiz-Santana1

Contact UsIntesive Care UnitHospital Universitario de Gran Canaria Dr NegrínLas Palmas de Gran Canaria, Spain

Main

Objectives

To prospectively evaluate the initial impact after 6 months of Selective Decontamination of the Digestive Tract (SDD) application to prevent nosocomial infections

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Main

Methods

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Prospective 6 month study each group in 30 bed medical-surgical ICU Two groups: Group A: patients admitted from April to September 2011. We applied head bed elevation 30 º to 45 º, cuff tube pressure control, and oral washes with chlorhexidine 0.12%, every 8 hours. And Protocol of Bacteremia Zero. Group B: patients admitted from October to March 2012. We applied same procedures and SDD.

Main

Methods

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Patients intubated expected to be more than 48 hours, or not intubated but they had neutropenia, severe pancreatitis or low level of conscience.

SDD:

We applied Inicial 4 day course of intravenous cefotaxime, plus enteral poliximin E, tobramycin, amphotericin B in an oropharyngeal paste and in a digestive solution.

Oropharyngeal and rectal swabs were obtained on admission and one weekly. Diagnostic samples were obtained if clinically indicated.

Main

Methods

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In each group: - Categorical variables frequencies or percentages (%) - Numerical variables means (SD) or medians (IR) - Percentages compared: Chi-square test - Means T-test - Medians Wilcoxon test

For each infection the incidences per 1000 days of exposure in each cohort using the Poisson regression

Stadistical significance was set at p≤ 0.05 Data was analized with SPSS

Statistical Analysis

Main

Results

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Main

SDD NoN = 43

YesN = 36

P

Male / Female, % 67.9 / 32.6 66.7 /33.3 .942Age, years 59.9 18.4 63.6 13.3 .302APACHE II score 20.6 7.7 23.6 8.8 .107ICU, n (%)

CardiologyNeurotrauma

Polyvalent

9 (20.9)20 (46.5)14 (32.6)

11 (30.6)11 (30.6)14 (38.9)

.331

Clinical status, n (%)No sepsis

SepsisSevere sepsis

Septic shock

1 (2.3)12 (27.9)12 (27.9)18 (41.9)

1 (2.8)6 (16.7)7 (19.4)

22 (61.1)

.373

Emergency surgery, n (%) 12 (27.9) 12 (33.3) .601Neutropenia, n (%) 1 (2.3) 1 (2.8) 1Immunodepression, n(%) 1 (2.3) 0 1Immunosuppression, n (%) 3 (7.0) 4 (11.1) .696Total parenteral nutrition, n (%) 11 (25.6) 17 (47.2) .045Coronary, n (%) 4 (9.3) 7 (19.4) .195ATB 48 hours before admission, n (%) 7 (16.3) 1 (2.8) .065Pseudomonas, n (%) 5 (11.6) 5 (13.9) .763Ventricular shunt, n (%) 1 (2.3) 0 1Renal replacement therapy, n (%) 11 (25.6) 17 (47.2) .045Transplant, n (%) 1 (2.3) 0 1Pneumonia, n (%) 25 (58.1) 13 (36.1) .051Urinary infection, n (%) 5 (11.6) 9 (25.0) .121Treatment ATB, n (%) 0 0 -Catheter related bacteriemia, n (%) 5 (11.6) 9 (25.0) .121Secondary bacteriemia, n (%) 14 (32.6) 11 (30.6) .849Clostridium P. infection, n (%) 0 0 1

Results

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Deaths

%

Days in

ICU

P = 0,197P = 0,419

Main

Results

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Nº infections per 1000 days

P= 0,009

Nosocomial infections

Main

Results

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P= 0,009

Nosocomial Pneumonia etiology (%)

Main

Results

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P ≥ 0,05

ARB Infections (Nº)

ARB: Antibiotic-Resistant Bacteria; Nª: number; ESBL: Extended Spectrum Beta-Lactamase; MRSA: Meticilin-resistant Staphilococcus Aureus; ARGNB: Antibiotic-resistant Gram Negative Bacteria

Main

Results

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Table 2: Antibiotic daily dose (DDS) / 100 days in ICU

ICU sections

Section 1   Section 2   Section 3  

SDD NO YES NO YES NO YES

Tobramycin 3.6 0 1.89 1.62 2.67 1.35

Amikacin 3.21 1.62 0.93 0.54 0 2.13

Ceftazidime 0.48 1.59 2.61 1.86 0 1.2

Ciprofloxacin 3.7 0.8 4.63 4.32 8.04 5.18

Meropenem 29.76 19.2 1.89 2.1 10.23 19.77

Imipenem 8.5 6.3 3.94 4.92 6.07 3.36

Vancomicyn 0.39 1.39 5.56 1.8 0.9 1.09

Colistin 10.24 12.88 0.45 0.04 0 1.48

Main

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ResultsDDD / 100 days in ICU

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Main

Figure 1. DDD/100 days in ICU. SDD:No _____________Yes----------------

Conclussions

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We have demonstrated a significant reduction in nosocomial pneumonia rates after six months of application of SDD without an increase of ARB infections.

Main