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Optimizing microbiological surveillance during selective digestive decontamination in the intensive care unit: an in
Jelle L G Haitsma Mulier1,2, Fleur J van Dijk3, Valentijn A Schweitzer4
1Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. j.l.g.haitsmamulier-2@umcutrecht.nl.
Critical Care (London, England)
|June 17, 2025
Summary
Optimizing microbiological surveillance during Selective Digestive Decontamination (SDD) in the ICU is key. Once-weekly monitoring offers a cost-effective balance, reducing expenses by 30% with minimal loss in detecting critical pathogens.
Area of Science:
- Intensive Care Medicine
- Infectious Disease Epidemiology
- Clinical Microbiology
Background:
- Selective Digestive Decontamination (SDD) is crucial for preventing infections and reducing mortality in intensive care units (ICUs).
- Effective SDD relies on microbiological surveillance to detect antibiotic resistance and guide decontamination protocols.
- The optimal frequency for microbiological surveillance during SDD remains undetermined.
Purpose of the Study:
- To compare the microbiological yield and associated costs of different surveillance frequencies during SDD.
- To evaluate the impact of surveillance intervals on the detection of potentially pathogenic microorganisms (PPMs) and colonization persistence.
- To inform optimal strategies for microbiological surveillance in SDD protocols.
Main Methods:
- A computational simulation study utilizing data from a Dutch ICU.
- Comparison of three surveillance scenarios: twice-weekly (A), once-weekly (B), and no surveillance (C).
- Primary outcome: number of clinically relevant PPMs detected; secondary outcomes: detection of colonization persistence and surveillance costs.
Main Results:
- Twice-weekly surveillance (A) detected 90 relevant PPMs per 1,000 days, while once-weekly (B) detected 85 and no surveillance (C) detected 77.
- Once-weekly surveillance (B) identified 43 cases of colonization persistence per 1,000 days, compared to 56 for twice-weekly (A) and 12 for no surveillance (C).
- Surveillance costs per 1,000 days were €78,774 (A), €55,208 (B), and €31,522 (C), indicating significant cost savings with reduced frequency.
Conclusions:
- Once-weekly microbiological surveillance during SDD reduces costs by 30% compared to twice-weekly, with only a 6% decrease in relevant PPM detection.
- Eliminating surveillance entirely cuts costs by 60% but results in a 14% loss of clinically relevant PPM detections.
- Adjusting surveillance frequency offers a trade-off between cost savings and detection of critical microorganisms in ICU settings.
Keywords:
CostsCulturesIntensive care unitMicrobiological surveillanceSelective digestive decontaminationSimulation
