Ventilator-associated pneumonia rates after introducing selective digestive tract decontamination

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Respiratory Medicine

Background:

• Ventilator-associated pneumonia (VAP) is a significant complication in intensive care units (ICUs).
• Current standard of care involves various strategies to prevent VAP.
• Selective decontamination protocols aim to reduce microbial colonization and subsequent VAP.

Purpose of the Study:

• To evaluate the impact of introducing selective oral decontamination (SOD) and selective digestive tract decontamination (SDD) on VAP incidence.
• To compare VAP rates before and after the implementation of these decontamination strategies in a general ICU population.

Main Methods:

• Retrospective analysis of 4945 mechanically ventilated patients over 37,554 ventilator days (2005-2013).
• SOD introduced as standard of care in December 2010; SDD (including SOD) in January 2012 for patients with expected ICU stay >= 48 hours.
• VAP diagnosis based on clinical criteria and quantitative bronchoalveolar lavage cultures.

Main Results:

• The incidence of VAP per 1000 ventilator days significantly decreased from 4.38 ± 1.64 before SOD/SDD implementation to 1.64 ± 0.43 after (p = 0.007).
• A substantial reduction in VAP rates was observed following the introduction of SOD and SDD protocols.

Conclusions:

• Implementation of SOD/SDD as standard of care in ICUs is effective in preventing VAP.
• These decontamination strategies represent a valuable approach to reducing VAP incidence in critically ill patients.