Selective Decontamination of the Digestive Tract in the ICU (SuDDICU)

Antibiotic resistance, driven by the overuse of antibiotics, is a huge threat to public health in Canada. At the same time infections are a major cause of death and drive health care costs. Critically ill patients are particularly susceptible to infections caused by antibiotic resistant organisms and have an even higher mortality. Significant tension exists between avoiding inappropriate antibiotic use and preventing life-threatening infections.

One intervention used to prevent infections and reduce deaths is selective decontamination of the digestive tract (SDD), a preventative antibiotic regimen. Health care professionals have refrained from using SDD due to fears that increased use of antibiotics will drive antibiotic resistance.

Whether these fears are justified is unknown. Currently, we deny patients a potentially life saving preventative therapy out of concern for the potential impact of antibiotic resistance on subsequent patients. Therefore further study is imperative to determine the balance of benefit and harm of this regimen.

We are funded by the CIHR’s Strategy for Patient Orientated Research (SPOR) to study whether SDD saves the lives of patients to whom it is delivered. Yet, this question is only one of the two key questions we need to answer before this treatment is implemented into practice. We also need to know whether this regimen drives antibiotic resistance potentially putting later patients lives at risk from difficult to treat infections caused by antibiotic resistant organisms.

We are currently conducting the fourth stage of the SuDDICU program of research. We are conducting a multi-centred RCT funded by SPOR in Canada of SDD (an antibiotic regimen) versus control and have recruited 5000 patients as of August 2022 in Canada. Alongside this RCT we are performing a massive cohort study of antibiotic resistance patterns in ICUs receiving SDD to answer the key question of whether this regimen drives antibiotic resistance. Recruitment ends in early 2023 and results will be available later that year. If the benefits of this treatment are realized without harming antibiotic resistance, this study could have global impact through lives saved and infections prevented as well as reducing health care expenditure.

Final patient enrolment of 5500 patients and data checks under way. Final combined paper expected early 2024.

For more information, visit SuDDICU: Selective Decontamination of the Digestive Tract in Intensive Care Unit patients.