DOI: 10.1097/01.pcc.0000449704.98053.ae
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Issn Print: 1529-7535
Publication Date: 2014/05/01
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Excerpt
Aims: To quantify tobramycin resistance in children treated with SDD.
Methods: SDD is used in a 22-bedded UK PICU (Alder Hey, Liverpool) admitting 1100 admissions per year. Seven months (01/05/2013-30/11/2013) prospectively collected data was reviewed. Microbiology provided details of tobramycin-resistant-bacteria from oral and rectal surveillance swabs on admission, repeated twice weekly. SDD consists of enteral colistin, tobramycin and amphotericin.
Results: Over seven months, 540 patients were admitted some repeatedly (674 admissions). 145 patients received SDD. (1-69 days treatment). 395 patients did not. 11 SDD recipients had one or more tobramycin-resistant samples (7.6%) compared with 5 patients who did not receive SDD (1.3%) P < 0.0005. 3 SDD-recipients had a tobramycin-resistant sample on ICU admission: two on first PICU admission. The remaining 8 SDD-recipients developed tobramycin-resistance between 22 - 243 days after SDD start. 4 non-SDD-recipients had tobramycin-resistance at ICU admission (first admission for 3). 1 developed tobramycin-resistance following ICU admission.
8 of 142 (5.6%) SDD-treated children (without tobramycin resistance on ICU admission) developed tobramycin resistance compared with 1 of 391 (0.3%) non-SDD treated children (P < 0.0005).
Conclusions: In this cohort we have found a relationship between SDD use and tobramycin resistance. It is important to recognise the limitations in drawing conclusions from the effect of non-random treatment allocation. A randomised-controlled trial is needed.
