Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey

David M Golding; Maxim Bloomfield; Joshua Davis; Anthony Delaney; Thomas Hills; Steven Y C Tong; Paul J Young

doi:10.1016/j.aucc.2024.101155

Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey

Aust Crit Care. 2025 Jan 20;38(3):101155. doi: 10.1016/j.aucc.2024.101155. Online ahead of print.

Authors

David M Golding¹, Maxim Bloomfield², Joshua Davis³, Anthony Delaney⁴, Thomas Hills⁵, Steven Y C Tong⁶, Paul J Young⁷

Affiliations

¹ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand. Electronic address: [email protected].
² Department of Infectious Diseases and Microbiology, Wellington Hospital, Wellington, New Zealand.
³ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Infection Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
⁴ The George Institute for Global Health, Sydney, New South Wales, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Northern Clinical School, Sydney Medical School, Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia.
⁵ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁶ Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁷ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Medical Research Institute of New Zealand, Wellington, New Zealand; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 39837052
DOI: 10.1016/j.aucc.2024.101155

Abstract

Objective: Selective decontamination of the digestive tract (SDD) has been investigated as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP) and other healthcare-associated infections in intensive care unit (ICU) patients receiving mechanical ventilation. There is some evidence to suggest that the use of SDD is associated with a reduction in healthcare-associated infection and mortality; however, the uptake of SDD in ICUs in Australia and New Zealand (ANZ) remains low. To better understand the potential reasons, we designed a questionnaire to gather views from specialists in intensive care medicine, infectious diseases, and medical microbiology.

Design: The study incorporated an online survey.

Setting and participants: An online survey was distributed to specialists in intensive care medicine, infectious diseases, and medical microbiology working in ANZ.

Main outcome measures: The main outcome measures are views about SDD and perceived barriers to implementation in ICUs in ANZ.

Results: A total of 103 responses were obtained, of which 55 were from intensive care medicine specialists and the remainder from infectious disease/medical microbiology specialists. No respondents currently used SDD in their hospital ICU. Intensive care medicine specialists self-reported better understanding of the evidence base regarding SDD (P = 0.032) and were more likely to believe that SDD was a safe therapy (P < 0.001) and that it was associated with a reduction in the incidence of VAP (P < 0.001) and ICU mortality (P < 0.001). Infectious disease/medical microbiology specialists were more likely to believe there is currently a lack of evidence of benefit (P < 0.001) and a risk of harm (P < 0.001) associated with SDD.

Conclusions: Specialists in intensive care medicine had more positive views about use of SDD in ventilated patients than did specialists in infectious diseases/medical microbiology, but no respondents reported using SDD in their clinical practice.

Keywords: Antibiotic prophylaxis; Infectious diseases; Intensive care; Microbiology; Selective digestive decontamination; Survey.