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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 July;81(7):734-42
Use of selective digestive tract decontamination in European intensive cares: the ifs and whys
Reis Miranda D. 1, Citerio G. 2, Perner A. 3, Dimopoulos G. 4, Torres A. 5, Hoes A. 6, Beale R. 7, De Smet A. M. 8, Kesecioglu J. 9 ✉
1 Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands;
2 Neuroanestesia e Neurorianimazione, Dipartimento di Medicina Perioperatoria e Terapie Intensive, Ospedale San Gerardo, Monza, Monza-Brianza, Italia;
3 Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark;
4 Department of Critical Care, ATTIKON University Hospital, Athens, Greece;
5 Servei de Pneumologia, Catedràtic de Medicina, Hospital Clínic, Barcelona, Spain;
6 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht,The Netherlands;
7 Department of Intensive Care, London Bridge Hospital, London, UK;
8 Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen,The Netherlands;
9 Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
BACKGROUND: Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multidrug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ERIC), in order to investigate the number of ICUs using SDD and the factors that prevented the use of SDD.
METHODS: One invitation to the electronic survey was sent to each ERIC unit. The survey focused on department characteristics (intensive care type, local resistance levels), local treatment modalities (antibiotic stewardship) and doctors’ opinions (collaborative issues concerning SDD). All ICU’s in countries participating in the European Centre for Disease Prevention and Control resistance surveillance program were analysed.
RESULTS: Seventeen percent of the ICUs registered in the ERIC database used SDD prophylaxis. Most of these ICUs were located in the Netherlands or Germany. ICUs using SDD were four times more likely to use antibiotic stewardship. Also larger ICUs were more likely to use SDD. On the contrary, resistance to antibiotics was not related to the use of SDD. Also the doctor’s opinion that SDD is proven in cluster-randomized trials was not a determinant for not using SDD.
CONCLUSION: SDD is used in a minority of the European ICUs registered in the ERIC database. Larger ICUs and ICUs with a prudent antibiotic policy were more likely to use SDD. Neither antibiotic resistance nor the cluster randomized study design were determinants of the non-use of SDD.