4CPS-194 Selective digestive decontamination in critically ill patients

<h3>Background and Importance</h3> Selective digestive decontamination (SDD) aims to reduce hospital-acquired infections in critically ill patients (CIP) by topical administration of non-absorbable antimicrobials in oropharynx and stomach and 4-days course of intravenous-antibiotic. SDD is elaborated in Pharmacy-Department. A multidisciplinary meeting is conducted weekly to decide the appropriate SDD for each CIP. <h3>Aim and Objectives</h3> To analyse the frequency of multidrug-resistant-bacteria (MDRB) colonisation/infection in CIP with SDD and the SDD-effectiveness of MDRB decolonisation. <h3>Material and Methods</h3> Prospective, observational and descriptive study. All adult patients admitted to ICU from December 2023 to July 2024 who received SDD were included. Age, sex, risk factors of colonisation (RFC) by MDRB, date of first MDRB-isolation and date of decolonisation in surveillance microbiological cultures, acquired-infection, ICU discharge date and outcome were collected. MDRB studied: Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), Vancomycin-resistant Enterococci (VRE), Extended-spectrum beta-lactamases and carbapenemase-producing Enterobacteriaceae (ESBLE, CPE) and Multidrug-resistant <i>Pseudomonas aeruginosa</i> (MDRPA) (resistant to three or more antibiotic-families). RFC by MDRB studied: Previous MDRB-colonisation/infection, transfer from social-health centre, previous hospital admission in last year, 48 hours or more in hospital ward prior to ICU admission, beta-lactams and/or quinolones treatment in last 90-days, chronic-dialysis, chronic skin-ulcers and permanent vesical-catheterisation. Qualitative variables were analysed by χ²-test. <h3>Results</h3> A total of 219 CIP were included. Median age was 71(IQR:59–78) years. 47.95% (105) had at least one RFC. Median ICU-days was nine (IQR:4–21). MDRB were isolated in microbiological surveillance-cultures in 13.70% (30) patients: 6.14% (seven) of non-RFC-group and 21.90% (23) of RFC-group. Overall, the presence of any RFC increased colonisation risk by 3.57 times, RR3.57 (95% CI 1.63–7.8) <i>p</i>=0.001. RFC with the greatest impact was previous MDRB-colonisation/infection, 69.23% (nine) of these patients (13) had MDRB-colonisations, RR6.79 (95% CI 3.47–13.29) <i>p</i>&lt;0.001. MDRB-colonisations were caused by: 31.25% (10) MRSA, 28.13% (nine) VRE, 28.13% (nine) ESBLE, 6.25% (two) MDRPA and 6.25% (two) CPE. Decolonisation success was: 100% CPE, 66.67% ESBLE, 50% MDRPA, 40% MRSA and 33.33% VRE. The overall decolonisation rate was 53.33% (16). VRE had the longest time to decolonise with a median of 14 (IQR:10.5–15.5) days, followed by CPE with 8.5 (IQR:6.75–10.25) days, ESBLE with six (IQR:5.25–8.25) days, MRSA with six (IQR:5 −9.50) days and MDRPA, only a patient was able to decolonise in 7 days. Acquired- infections occurred in 13.33% (four): 50% (two) MRSA, 25% (one) VRE and 25% (one) MDRPA. <h3>Conclusion and Relevance</h3> Recognition of RFC is a correct practice to identify patients who benefit from the implementation of SDD targeted at MDRB. The fact that some MDRB are not successfully decolonised may be due to the need for more days of SDD exposure or an inadequate antimicrobial combination. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest