The effect of selective decontamination on antimicrobial resistance in intensive care patients: a systematic review and meta-analysis

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Abstract Background Selective Digestive Decontamination (SDD) and Selective Oropharyngeal Decontamination (SOD) are applied to prevent infections amongst Intensive Care Unit (ICU) patients and have proven to reduce mortality and infection rates. However, concerns about development of antimicrobial resistance persists, specifically after ICU discharge. The aim of this study was to assess the occurrence of antimicrobial resistance during ICU stay and after ICU discharge in patients who received SDD, or SOD compared to control. Methods A previous systematic review, which included studies on antimicrobial resistance after SDD or SOD from before 01-02-2012, was updated. All studies analyzing antimicrobial resistance during and after ICU stay, were included. Pooled odds ratios and 95% confidence intervals were calculated using the Mantel-Haenszel method with random effects. Analyses were done separately for SDD and SOD. Results Twenty-seven studies were included in the meta-analysis on the occurrence of antimicrobial resistance during ICU stay, yielding a protective association in patients receiving SDD; OR 0.73 (95%-CI 0.54;0.98, I 2 75%), less resistance to fluoroquinolones in patients receiving SDD OR 0.29 (95%-CI 0.12;0.68, I 2 30%) and less multi-resistant bacteria; OR 0.53 (95%-CI 0.33; 0.87, I 2 0%), compared to control treatment. Four studies investigated antimicrobial resistance after ICU discharge of which two were eligible for pooling, which yielded no significant effect; OR 1.20 (95%-CI 0.23;6.36, I 2 90%). Conclusion During ICU stay, SDD is associated with reduced antimicrobial resistance to specific antibiotics, in line with a previous review. More specifically combined with intravenous (IV) component, in settings with low prevalence of resistance and in a cluster design. This current review emphasizes the limited amount of data on the long-term effect of antimicrobial decontamination strategies to antimicrobial resistance. Understanding this long-term effect is essential when deciding whether to implement preventative antibiotics in specific subgroups. This could be done by means of a prospective long-term follow-up study.

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