Descontaminación digestiva selectiva: repercusión en la carga de trabajo y el coste del laboratorio de microbiología y tendencias en la resistencia bacteriana / Selective decontamination of the digestive tract: Repercussions on microbiology laboratory workload and costs, and antibiotic resistance trends

Introducción Determinar la carga de trabajo y el coste para el laboratorio de microbiología así como el impacto en la flora microbiana y las tendencias de la resistencia bacteriana en el servicio de medicina intensiva (SMI) a partir de la introducción de la descontaminación digestiva selectiva. Métodos Se cuantificó la carga de trabajo y el coste total de microbiología así como la parte imputada al servicio peticionario en el año anterior y posterior a la introducción del procedimiento. Se valoró el cambio en la flora microbiana y se analizaron las tendencias de resistencia bacteriana durante 12 años en 21 combinaciones centinela antimicrobiano/microorganismo. Resultados La carga de trabajo imputada al SMI aumentó un 10% y el coste un 1,8% en el período posterior a la introducción del procedimiento (diferencias no significativas). El aumento de la carga de trabajo a costa de los cultivos de vigilancia epidemiológica se compensó con disminuciones significativas de broncoaspirados cuantitativos, hemocultivos, exudados, identificaciones y antibiogramas, y serología. El procedimiento se ha asociado a una disminución significativa de aislados de Acinetobacter y a un ascenso significativo de Enterococcus. Se han detectado 3 tendencias significativas de aumento de resistencia, las 3 en Pseudomonas aeruginosa (imipenem, tobramicina y ciprofloxacino).Conclusiones En este hospital, la implantación de este procedimiento no ha supuesto un aumento significativo de la carga de trabajo y el coste del laboratorio de microbiología, y se ha asociado a una marcada disminución de Acinetobacter y a un aumento de Enterococcus y de la resistencia a imipenem, tobramicina y ciprofloxacino en P. aeruginosa (AU)

Introduction This study determines the workload and cost of implementing selective digestive decontamination in the microbiology laboratory, and reports the impact on microbial flora and bacterial resistance trends in the intensive care unit (ICU).Methods The total microbiological workload and cost were quantified, as well as the part charged to the petitioning service, in the year before and the year after introducing the procedure. Changes in microbial flora were evaluated and bacterial resistance trends were analyzed over 12 years in 21 sentinel antimicrobial/microorganism combinations. Results The workload ascribed to the ICU increased by 10% and cost increased by 1.8% in the period after introduction of the procedure (non-significant differences). The increased workload resulting from epidemiological surveillance cultures was compensated by significant reductions in quantitative endotracheal aspirate cultures, blood cultures, exudate cultures, identification tests with antibiograms, and serologies. The procedure has been associated with a significant decrease in Acinetobacter isolates and a significant increase in Enterococcus. Three significant trends of increased resistance were detected, all of them in Pseudomonas aeruginosa (imipenem, tobramycin, and ciprofloxacin).Conclusions In our hospital, implementation of selective digestive decontamination did not cause a significant increase in the workload or costs in the microbiology laboratory. Selective digestive decontamination was associated with a significant decrease in Acinetobacter, an increase in Enterococcus, and higher resistance to imipenem, tobramycin and ciprofloxacin in P. aeruginosa(AU)

[Selective decontamination of the digestive tract: repercussions on microbiology laboratory workload and costs, and antibiotic resistance trends]. / Descontaminación digestiva selectiva: repercusión en la carga de trabajo y el coste del laboratorio de microbiología y tendencias en la resistencia bacteriana.

INTRODUCTION: This study determines the workload and cost of implementing selective digestive decontamination in the microbiology laboratory, and reports the impact on microbial flora and bacterial resistance trends in the intensive care unit (ICU). METHODS: The total microbiological workload and cost were quantified, as well as the part charged to the petitioning service, in the year before and the year after introducing the procedure. Changes in microbial flora were evaluated and bacterial resistance trends were analyzed over 12 years in 21 sentinel antimicrobial/microorganism combinations. RESULTS: The workload ascribed to the ICU increased by 10% and cost increased by 1.8% in the period after introduction of the procedure (non-significant differences). The increased workload resulting from epidemiological surveillance cultures was compensated by significant reductions in quantitative endotracheal aspirate cultures, blood cultures, exudate cultures, identification tests with antibiograms, and serologies. The procedure has been associated with a significant decrease in Acinetobacter isolates and a significant increase in Enterococcus. Three significant trends of increased resistance were detected, all of them in Pseudomonas aeruginosa (imipenem, tobramycin, and ciprofloxacin). CONCLUSIONS: In our hospital, implementation of selective digestive decontamination did not cause a significant increase in the workload or costs in the microbiology laboratory. Selective digestive decontamination was associated with a significant decrease in Acinetobacter, an increase in Enterococcus, and higher resistance to imipenem, tobramycin and ciprofloxacin in P. aeruginosa.