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Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units

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Abstract

Purpose

Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selective decontamination on acquisition of colistin-resistant gram-negative bacteria (GNB) using data from a cluster-randomized study and a single-centre cohort.

Methods

Acquisition of colistin-resistant GNB and conversion from susceptible to resistance in GNB was determined in respiratory samples [from patients receiving SDD (n = 455), SOD (n = 476), or standard care (SC) (n = 315)], and in rectal swabs from 1,840 SDD-patients. Genotyping of converting isolates was performed where possible.

Results

The respiratory tract acquisition rates of colistin-resistant GNB were comparable during SDD, SOD, and SC and ranged from 0.7 to 1.1/1,000 patient-days at risk. Rectal acquisition rates during SDD were <3.3/1,000 days at risk. In patients with respiratory tract GNB carriage, conversion rates were 3.6 and 1.1/1,000 patient-days at risk during SDD and SC, respectively, (p > 0.05). In patients with rectal GNB carriage conversion rates during SDD were 5.4 and 3.2/1,000 days at risk and 15.5 and 12.6/1,000 days at risk when colonized with tobramycin-resistant GNB.

Conclusions

Acquisition rates with colistin-resistant GNB in the respiratory tract were low and comparable with and without topical use of colistin. Rates of acquisition of colistin-resistant GNB during SDD were—in ICUs with low endemicity of antibiotic resistance—<2.5/1,000 days at risk, but were fivefold higher during persistent GNB colonization and 15-fold higher during carriage with tobramycin-resistant GNB.

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Acknowledgments

We thank Hans (J) G. Kusters and Matthijs van Drongelen for genotyping. No financial support was provided. M.J.M. Bonten is supported by The Netherlands Organization of Scientific Research (NWO-VICI 918.76.611).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA, Utrecht, The Netherlands

    Evelien A. N. Oostdijk, Loek Smits, Maurine A. Leverstein-van Hall & Marc J. M. Bonten

  2. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    Evelien A. N. Oostdijk & Jozef Kesecioglu

  3. Department of Critical Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Anne Marie G. A. de Smet

  4. Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Utrecht, The Netherlands

    Maurine A. Leverstein-van Hall

  5. Department of Medical Microbiology, Bronovo Hospital, The Hague, The Netherlands

    Maurine A. Leverstein-van Hall

  6. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Marc J. M. Bonten

Authors
  1. Evelien A. N. Oostdijk
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  2. Loek Smits
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  3. Anne Marie G. A. de Smet
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  5. Jozef Kesecioglu
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  6. Marc J. M. Bonten
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Corresponding author

Correspondence to Evelien A. N. Oostdijk.

Additional information

E.A.N. Oostdijk and L. Smits contributed equally to the manuscript.

This work was presented in part at the 21th European Congress of Clinical Microbiology and Infectious Diseases, Milan, Italy, May 7–10, 2011.

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Appendix

Appendix

The Dutch SOD-SDD trialists group include the following persons and sites:

Cor J. Kalkman, Hans (J.) C.A. Joore, Hetty E.M Blok, University Medical Center Utrecht, Utrecht; Jan A.J.W Kluytmans, Nardo J.M van der Meer, Amphia Hospital, Breda; Ellen M. Mascini, Karin Kaasjager, Frank H. Bosch, Rijnstate Hospital, Arnhem; Robin F.J. Benus, Tjip S. van der Werf, University Medical Center, Groningen; Johannes G. van der Hoeven, Peter Pickkers, Patrick D.J. Sturm, Andreas Voss, Radboud University, Nijmegen Medical Center, Nijmegen; Alexander.J.G.H. Bindels, Arjan R. Jansz, Catharina Hospital, Eindhoven; Mat van Iterson, Steven F.T. Thijsen, Diakonessen Hospital, Utrecht; Georg H. Kluge, Slotervaart Hospital, Amsterdam; Jacob W. de Vries, Jan A. Kaan, Mesos Medical Center, Utrecht — all in the Netherlands.

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Oostdijk, E.A.N., Smits, L., de Smet, A.M.G.A. et al. Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units. Intensive Care Med 39, 653–660 (2013). https://doi.org/10.1007/s00134-012-2761-3

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