Evidence map›Paper›PMID 29843808›Full record

ArticleCritical care (London, England)2018

Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance.

Catalina Sánchez-Ramírez, Silvia Hípola-Escalada, Miriam Cabrera-Santana, María Adela Hernández-Viera, Liliana Caipe-Balcázar, Pedro Saavedra, Fernando Artiles-Campelo, Nayra Sangil-Monroy, Carlos Federico Lübbe-Vázquez, Sergio Ruiz-Santana

Abstract read
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In one paragraph

Article in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Review
  5. Review
  6. Review
  7. Review
  8. Effect of the implementation of a selective digestive decontamination protocol in an intensive care unit.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2025
    Article
  9. Article
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  15. Selective digestive decontamination - Pro.Intensive care medicine · 2023
    Article
  16. The threat of multidrug-resistant/extensively drug-resistant Gram-negative respiratory infections: another pandemic.European respiratory review : an official journal of the European Respiratory Society · 2022
    Article
  17. Review
  18. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Catalina Sánchez-RamírezIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain. catalinasanchezramirez@gmail.com.ORCID 0000-0002-7951-5300
Silvia Hípola-EscaladaIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.
Miriam Cabrera-SantanaIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.
María Adela Hernández-VieraIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.
Liliana Caipe-BalcázarIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.
Pedro SaavedraMathematics Department, Universidad de las Palmas de Gran Canaria, Las Palmas, Spain.
Fernando Artiles-CampeloMicrobiology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain.
Nayra Sangil-MonroyPharmacy Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain.
Carlos Federico Lübbe-VázquezIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.
Sergio Ruiz-SantanaIntensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010, Las Palmas, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe examined whether long-term use of selective digestive tract decontamination (SDD) was effective in reducing intensive care unit (ICU)-acquired infection and antibiotic consumption while decreasing colistin-, tobramycin-, and most of the antibiotic-resistant colonization rates in a mixed ICU with a high endemic level of multidrug-resistant bacteria (MDRB).

methodsIn this cohort study, which was conducted in a 30-bed medical-surgical ICU, clinical outcomes before (1 year, non-SDD group) and after (4 years) implementation of SDD were compared. ICU patients who were expected to require tracheal intubation for > 48 hours were given a standard prophylactic SDD regimen. Oropharyngeal and rectal swabs were obtained on admission and once weekly thereafter.

resultsICU-acquired infections occurred in 110 patients in the non-SDD group and in 258 in the SDD group. A significant (P <  0.001) reduction of infections caused by MDRB (risk ratio [RR], 0.31; 95% CI, 0.23-0.41) was found after SDD and was associated with low rates of colistin- and tobramycin-resistant colonization. Colistin- and tobramycin-acquired increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at admission, was nonsignificant (0.82; 95% CI, 0.56 to 1.95; 1.13; 95% CI, 0.75 to 1.70, respectively). SDD was also a protective factor for ICU-acquired infections caused by MDR gram-negative pathogens and Acinetobacter baumannii in the multivariate analysis. In addition, a significant (P <  0.001) reduction of ventilator-associated pneumonia (VAP) (RR, 0.43; 95% CI, 0.32-0.59) and secondary bloodstream infection (BSI) (RR, 0.35; 95% CI, 0.24-0.52) was found. A decrease in antibiotic consumption was also observed.

conclusionsTreatment with SDD during 4 years was effective in an ICU setting with a high level of resistance, with clinically relevant reductions of infections caused by MDRB, and with low rates of colistin- and tobramycin-resistant colonization with nonsignificant increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at ICU admission. In addition, VAP and secondary BSI rates were significantly lower after SDD. Notably, a decrease in antimicrobial consumption was also observed.

Indexed as

AdultAnti-Bacterial AgentsBacterial InfectionsCohort StudiesColistinDecontaminationDrug Resistance, BacterialFemaleGastrointestinal TractHumansIntensive Care UnitsMaleMiddle AgedProspective StudiesProtective FactorsSpainAnti-Bacterial AgentsColistinTobramycinBloodstream infectionColistinDrug resistanceICU-acquired infectionMultidrug-resistant pathogensSelective digestive decontaminationTobramycinVentilator-associated pneumonia

Identifiers

PMID29843808
PMCPMC5975678

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.