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

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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METHODSProspective, 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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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

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)5 of 11

Statistical Analysis

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SDDNumber of infections

Non = 110

Yesn = 55

P

Male / Female, % 72.7 / 27.3 68.2 / 31.8 .549Age, years 57.9 18.5 59.6 15.8 . 539APACHE II score 22.5 7.2 21.2 7.6 . 282

Clinical status, n (%)No sepsis

SepsisSevere 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) .082Neutropenia, n (%) 1 (1.8) 3 (2.7) 1

Immunosuppression, n (%) 5 (9.1) 7 (6.4) .525Total parenteral nutrition, n (%) 17 (30.9) 26 (23.6) .316Coronary, n (%) 8 (14.5) 19 (17.3) .655ATB 48 hours before admission, n (%) 8 (14.5) 28 (25.5) .110Ventricular shunt, n (%) 7 (12.7) 11 (10.0) .596Renal replacement therapy, n (%) 19 (34.5) 34 (30.9) . 637

Traumatic patient, n (%) 8 (14.5) 17 (15.5) .878

Nº ARB infections, n (%)01

≥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

RESULTS

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Days in ICU

168

62

A B

Deaths%

A B25

26

27

28

29

30

31

32

33

27.3

31.8

p = 0.549

RESULTS

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Nosocomial infection rates and relative risks ( RR)

SDD

Non = 110

Yesn = 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 ]

RESULTS

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8

39

7 101

03

13

1

12

ESBL bacteria

Pseudomonas AeruginosaMRSA

Acinetobacter BaumanniiARGNB

p: 0.005

ARB Infections (nº)

RESULTS

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Defined antibiotic Daily Doses (DDD) grs / 100 ICU days

Amikacin

Ceftazidim

e

Ciprofloxa

cin

Imipenem

Colistin

Vanco

micyn

Columna1SDD GROUP non-SDD

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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