Impact of a selective digestive decontamination and nasal mupirocin on the incidence of ventilatory-associated pneumonia and the emergence of bacterial resistance

Introduction

Selective digestive decontamination (SDD) can reduce the incidence of ventilatory-associated pneumonia (VAP). Some concerns have been raised about the risk of selection of resistant bacteria. We evaluated the impact of a SDD regimen on the incidence of VAP and the development of resistant pathogens.

Methods

In a polyvalent eight-bed ICU, a retrospective analysis was performed of two periods of 8 months before (no-SDD, 178 patients, mean SAPS II 44.8) and after (SDD, 110 patients, mean SAPS II 48.9) the use of SDD with amphotericin, tobramycin and colistin for oropharyngeal and gastric decontamination and mupirocin for nasal decontamination. The results were analyzed with the chi-square test.

Results

The incidence of VAP was reduced in the SDD group, even though it was not statistically significant (26.9% vs 16.3%, P = 0.138). The mortality of VAP and septic shock was reduced respectively from 39.6% to 16.7% (P = 0.312) and from 60% to 37.5% (P = 0.835). During the SDD period, Gram-positive infections increased while Gram-negative infections and Candida infections showed a reduction. The percentage of resistant species showed a reduction from 49.1% to 30.5% in all the categories of pathogens (Table 1).

Table 1 Percentages of pathogens

Conclusion

SDD and mupirocin were correlated to a reduced incidence of VAP and mortality and to a reduction of resistant species.