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Original article
Available online 19 June 2024
Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study
La descontaminación digestiva selectiva en una Unidad de Quemados disminuye la incidencia de infecciones de adquisición hospitalaria: estudio de cohortes retrospectivo antes-después
David Pérez-Torresa,b,c,
Corresponding author
dperezt@saludcastillayleon.es

Corresponding author.
, Ana Isabel Martín-Luengoa,b, Cristina Cuenca-Rubioa, José Ángel Berezo-Garcíaa,b, Cristina Díaz-Rodrígueza,b, Isabel Canas-Péreza, María Lorena Fernández-Rodrígueza,b, Cristina Colmenero-Callejaa, Jesús Sánchez-Ballesterosa,b, Pablo Blanco-Schweizera,b, Thalia Gloria Ticona-Espinozaa, José María Piqueras-Pérezb,d
a Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
b Unidad de Quemados, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
c Programa de Optimización del Uso de Antimicrobianos (PROA), Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
d Servicio de Cirugía Plástica, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
Received 28 March 2024. Accepted 17 May 2024
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Statistics
Tables (5)
Table 1. Baseline Characteristics.
Table 2. Incidence of Hospital-Acquired Infections for Patients With a Length of BU Stay More Than 2 Days.
Table 3. Number of Hospital-Acquired Infectious Episodes Per Patient and Time to Infection for Patients with a Length of BU Stay More Than 2 Days.
Table 4. Safety Endpoints.
Table 5. Logistic regression analysis examining the influence of predictor variables on the incidence of HAIs. The model as a whole was significant (n=72, LR χ2(3)=35.02, pseudo-R2=0.36, p<0.001, Akaike’s information criterion [AIC]=70.79).
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Abstract
Objective

To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU).

Design

Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups.

Setting

Four-bed BU, in a referral University Hospital in Spain.

Patients

All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded.

Intervention

SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU.

Main variable of interest

Incidence of HAIs during the stay in the BU. Secondary outcomes: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints.

Results

We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21–3.82) and 1.13 (0.54–1.73), respectively (p=0.029).

Conclusions

SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.

Keywords:
Selective decontamination of the digestive tract
Selective digestive decontamination
Burns unit
Burn patients
Prevention
Infection
Hospital-acquired infections
Ventilator-associated pneumonia
Bloodstream infections
Bacteremia
Abbreviations:
ABLS
ABSI
AIC
APACHE
ASP
ATLS
BET
BU
CFU
CI
EMR
ENVIN-HELICS
HAI
ICU
IQR
MDRB
MV
No.
OR
RCT
SDD
SEMICYUC
STROBE
TBSA
VAP
Resumen
Objetivo

Evaluar el efecto de la descontaminación digestiva selectiva (DDS) en las infecciones de adquisición hospitalaria (IAH) en pacientes con quemadura en una Unidad de Quemados (UQ).

Diseño

Cohorte retrospectiva antes-después, entre enero de 2017 y junio de 2023. La DDS se implementó en marzo de 2019, dividiendo los pacientes en dos grupos.

Ámbito

UQ de cuatro camas, en hospital universitario de referencia en España.

Pacientes

Todos los pacientes ingresados durante el periodo de estudio fueron elegibles para el análisis. Excluimos a aquellos que fallecieron o recibieron el alta en las primeras 48 horas de ingreso, y a aquellos con una supervivencia predicha menor del 10% que no fueran candidatos a tratamiento completo.

Intervención

La DDS incluyó la administración de un ciclo de antibiótico intravenoso durante 4 días, y una suspensión y pasta tópica oral de antibióticos no absorbibles durante la estancia en UQ.

Variable de interés principal

Incidencia de IAH durante la estancia en UQ. Desenlaces secundarios: incidencia de infecciones por localización (bacteriemia, neumonía, piel/partes blandas) y microorganismo (Gram-positivos, Gram-negativos, hongos), y desenlaces de seguridad.

Resultados

Analizamos 72 pacientes: 27 no recibieron DDS, y 45 recibieron DDS. El número de pacientes que desarrolló IAH fue 21 (77.8%) y 21 (46.7%) en los grupos sin y con DDS, respectivamente (p=0.009). El número de episodios de IAH fue 2.52 (1.21–3.82) y 1.13 (0.54–1.73), respectivamente (p=0.029).

Conclusiones

La DDS se asocia a una reducción en la incidencia de IAH, y de episodios de infección por paciente.

Palabras clave:
Descontaminación selectiva del tracto digestivo
Descontaminación digestiva selectiva
Unidad de quemados
Paciente quemado
Prevención
Infección
Infección de adquisición hospitalaria
Neumonía asociada a ventilación mecánica
Infección del torrente sanguíneo
Bacteriemia

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