Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study

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: Bacteremia; Bacteriemia; Bloodstream infections; Burn patients; Burns unit; Descontaminación digestiva selectiva; Descontaminación selectiva del tracto digestivo; Hospital-acquired infections; Infección; Infección de adquisición hospitalaria; Infección del torrente sanguíneo; Infection; Neumonía asociada a ventilación mecánica; Paciente quemado; Prevención; Prevention; Selective decontamination of the digestive tract; Selective digestive decontamination; Unidad de quemados; Ventilator-associated pneumonia.