This study evaluated the impact of selective decontamination of the digestive tract (SDD) over one year in a mixed intensive care unit (ICU). They found that SDD was associated with: 1) A significant reduction in rates of nosocomial pneumonia, secondary bacteremia, and urinary tract infections. 2) A significant decrease in antibiotic-resistant bacteria infections with no cases of Clostridium difficile infection. 3) An important reduction in antibiotic consumption.

1. IMPACT OF ONE YEAR APPLICATION OF
SELECTIVE DECONTAMINATION OF THE
DIGESTIVE TRACT IN A MIXED INTENSIVE
CARE UNIT IN A UNIVERSITY TERTIARY-
CARE HOSPITAL.
C. Sánchez Ramírez1, M. Cabrera Santana1, M.A. Hernández
Viera1, J.L. Romero luján1 ,S. Hípola Escalada1 ,N. Sangil
Monroy2, A. Bordes Benitez3, P. Saavedra Santana4, S. Ruiz-
Santana1
1University Hospital of Gran Canaria Dr NegrínIntensive 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
CCC

2. OBJECTIVES
To prospectively evaluate:
Initial impact, after 1 year, of SDD application to:
- Prevent nosocomial infection
- Decrease or not antibiotic resitant bacteria (ARB)
infections.
- Antibiotic consumption
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3. METHODS
Prospective, 1 year study, in a 30 bed medical-surgical ICU
Two study groups:
Group A:
Patients admitted from October 2010 / September 2011.
We applied:
HOB 30 º to 45 º, cuff tube pressure control, and oral washes with chlorhexidine
0.12%, every 8 hours.
Group B:
Patients admitted from October 2011 / September 2012.
We applied:
Same preventive procedures (above described) and SDD.
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4. METHODS
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We applied a 4 day course of I.V. cefotaxime after ICU admission,
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.
Patients:
• Intubated: expected to be more than 48 hours on M.V.
• Not intubated: diagnosed of neutropenia, severe pancreatitis or low
level of conscience.
SDD

5. METHODS
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 incidences per 1000 days of exposure in each
cohort/corresponding RR were obtained, using the Poisson regression
Statistical significance was set at p≤ 0.05
Data was analized using PASW statistical software (SPSS)
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Statistical Analysis

6. 6
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SDD
Number of infections
No
n = 110
Yes
n = 55
P
Male / Female, % 72.7 / 27.3 68.2 / 31.8 .549
Age, years 57.9 18.5 59.6 15.8 . 539
APACHE II score 22.5 7.2 21.2 7.6 . 282
Clinical status, n (%)
No sepsis
Sepsis
Severe sepsis
Septic shock
1 (1.8)
10 (18.2)
7 (12.7)
37 (67.3)
2 (1.8)
23 (20.9)
34 (30.9)
51 (46.4)
.046
Emergency surgery, n (%) 24( 43.6) 33 (30.0) .082
Neutropenia, n (%) 1 (1.8) 3 (2.7) 1
Immunosuppression, n (%) 5 (9.1) 7 (6.4) .525
Total parenteral nutrition, n (%) 17 (30.9) 26 (23.6) .316
Coronary, n (%) 8 (14.5) 19 (17.3) .655
ATB 48 hours before admission, n (%) 8 (14.5) 28 (25.5) .110
Ventricular shunt, n (%) 7 (12.7) 11 (10.0) .596
Renal replacement therapy, n (%) 19 (34.5) 34 (30.9) . 637
Traumatic patient, n (%) 8 (14.5) 17 (15.5) .878
Nº ARB infections, n (%)
0
1
≥1
37 (67.3)
15 (27.3)
3 (5.5)
49 (44.5)
45 (40.9)
16 (14
.017
Clostridium difficile. infection, n (%) 0 0 1

7. RESULTS
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Days in ICU
168
62
A B
Deaths%
27.3
31.8
25
26
27
28
29
30
31
32
33
A B
p = 0.549

8. RESULTS
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Nosocomial infection rates and relative risks ( RR)
SDD
No
n = 110
Yes
n = 55
p RR (95%CI)
n º CRB /1000 days of CVC 3.735 2.309 .122 0.620 [ 0.338 ; 1.137 ]
nº Other secondary bacteriemias/1000 days in ICU 4.686 1.951 .002 0.416[ 0.240 ; 0.722 ]
nº Nosocomial pneumonia/1000 days of MV 10.30 4.35 .001 0.430 [ 0.276 ; 0.672 ]
nº Urinary infections/1000 days urinary catheter 3.905 1.605 .005 0. 414 [0.222 ; 0.771 ]

9. RESULTS
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B
8
39
7
10
1
0
3
13
1
12
ESBLbacteria
Pseudomonas
Aeruginosa
MRSA
Acinetobacter
Baumannii
ARGNB
p: 0.005
ARB Infections (nº)

10. RESULTS
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Defined antibiotic Daily Doses (DDD) grs / 100 ICU days
Column
a1
SDD
GROUP
non-
SDD

11. CONCLUSIONS
We have demonstrated, after 1 year of SDD application in a University
Hospital:
- A significant reduction in nosocomial pneumonia, secondary bacteremia
and urinary tract rates.
- A significant decrease of ARB infections without any Clostridium
difficile infections.
- A important reduction of antibiotic consumption.
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