1. Selective Decontamination of the Digestive
tract in a mixed ICU in a University tertiary-
care hospital: Initial 6 months impact
C. Sánchez Ramírez 1, 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
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
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2. 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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3. Methods
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.
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4. Methods
SDD:
Patients intubated expected to be more than 48 hours, or not
intubated but they had neutropenia, severe pancreatitis or low level
of conscience.
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.
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5. Methods
Statistical Analysis
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
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6. Results
SDD No Yes P
N = 43 N = 36
Male / Female, % 67.9 / 32.6 66.7 /33.3 .942
Age, years 59.9 ± 18.4 63.6 ± 13.3 .302
APACHE II score 20.6 ± 7.7 23.6 ± 8.8 .107
ICU, n (%) .331
Cardiology 9 (20.9) 11 (30.6)
Neurotrauma 20 (46.5) 11 (30.6)
Polyvalent 14 (32.6) 14 (38.9)
Clinical status, n (%) .373
No sepsis 1 (2.3) 1 (2.8)
Sepsis 12 (27.9) 6 (16.7)
Severe sepsis 12 (27.9) 7 (19.4)
Septic shock 18 (41.9) 22 (61.1)
Emergency surgery, n (%) 12 (27.9) 12 (33.3) .601
Neutropenia, n (%) 1 (2.3) 1 (2.8) 1
Immunodepression, n(%) 1 (2.3) 0 1
Immunosuppression, n (%) 3 (7.0) 4 (11.1) .696
Total parenteral nutrition, n (%) 11 (25.6) 17 (47.2) .045
Coronary, n (%) 4 (9.3) 7 (19.4) .195
ATB 48 hours before admission, n (%) 7 (16.3) 1 (2.8) .065
Pseudomonas, n (%) 5 (11.6) 5 (13.9) .763
Ventricular shunt, n (%) 1 (2.3) 0 1
Renal replacement therapy, n (%) 11 (25.6) 17 (47.2) .045
Transplant, n (%) 1 (2.3) 0 1
Pneumonia, n (%) 25 (58.1) 13 (36.1) .051
Urinary infection, n (%) 5 (11.6) 9 (25.0) .121
Treatment ATB, n (%) 0 0 -
Catheter related bacteriemia, n (%) 5 (11.6) 9 (25.0) .121
Secondary bacteriemia, n (%) 14 (32.6) 11 (30.6) .849
Clostridium P. infection, n (%) 0 0 1
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7. Results
Deaths % Days in ICU
P = 0,419
P = 0,197
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8. Results
Nosocomial infections
P= 0,009
Nº infections per 1000 days
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9. Results
Nosocomial Pneumonia etiology (%)
P= 0,009
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10. Results
ARB Infections (Nº)
P ≥ 0,05
ARB: Antibiotic-Resistant Bacteria; Nª:
number; ESBL: Extended Spectrum Beta-
Lactamase; MRSA: Meticilin-resistant
Staphilococcus Aureus; ARGNB: Antibiotic-
resistant Gram Negative Bacteria
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11. Results
Table 2: Antibiotic daily dose (DDS) / 100 days in ICU
ICU Section 1 Section 2 Section 3
sections
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
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12. Results
DDD / 100 days in ICU
Figure 1. DDD/100 days in ICU.
SDD:No _____________Yes----------------
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13. Conclussions
We have demonstrated a significant
reduction in nosocomial pneumonia rates
after six months of application of SDD
without an increase of ARB infections.
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