Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study)
Objective Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated wi...
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Online Access: | http://dx.doi.org/10.1136/gutjnl-2023-330851 https://syndication.highwire.org/content/doi/10.1136/gutjnl-2023-330851 |
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crjcrbmj:10.1136/gutjnl-2023-330851 2024-06-23T07:50:44+00:00 Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) Kean, Iain Robert Louis Clark, John A Zhang, Zhenguang Daubney, Esther White, Deborah Ferrando-Vivas, Paloma Milla, Gema Cuthbertson, Brian Pappachan, John Klein, Nigel Mouncey, Paul Rowan, Kathy Myburgh, John Gouliouris, Theodore Baker, Stephen Parkhill, Julian Pathan, Nazima ARCTIC research team Action Medical Research Addenbrooke's Charitable Trust, Cambridge University Hospitals Wellcome Trust NIHR Cambridge Biomedical Research Centre 2024 http://dx.doi.org/10.1136/gutjnl-2023-330851 https://syndication.highwire.org/content/doi/10.1136/gutjnl-2023-330851 en eng BMJ https://creativecommons.org/licenses/by/4.0/ Gut volume 73, issue 6, page 910-921 ISSN 0017-5749 1468-3288 journal-article 2024 crjcrbmj https://doi.org/10.1136/gutjnl-2023-330851 2024-06-13T04:15:25Z Objective Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control. Design We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care. Results SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment. Conclusion Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy. Article in Journal/Newspaper Arctic The BMJ Arctic Gut 73 6 910 921 |
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The BMJ |
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crjcrbmj |
language |
English |
description |
Objective Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control. Design We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care. Results SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment. Conclusion Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy. |
author2 |
Action Medical Research Addenbrooke's Charitable Trust, Cambridge University Hospitals Wellcome Trust NIHR Cambridge Biomedical Research Centre |
format |
Article in Journal/Newspaper |
author |
Kean, Iain Robert Louis Clark, John A Zhang, Zhenguang Daubney, Esther White, Deborah Ferrando-Vivas, Paloma Milla, Gema Cuthbertson, Brian Pappachan, John Klein, Nigel Mouncey, Paul Rowan, Kathy Myburgh, John Gouliouris, Theodore Baker, Stephen Parkhill, Julian Pathan, Nazima ARCTIC research team |
spellingShingle |
Kean, Iain Robert Louis Clark, John A Zhang, Zhenguang Daubney, Esther White, Deborah Ferrando-Vivas, Paloma Milla, Gema Cuthbertson, Brian Pappachan, John Klein, Nigel Mouncey, Paul Rowan, Kathy Myburgh, John Gouliouris, Theodore Baker, Stephen Parkhill, Julian Pathan, Nazima ARCTIC research team Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
author_facet |
Kean, Iain Robert Louis Clark, John A Zhang, Zhenguang Daubney, Esther White, Deborah Ferrando-Vivas, Paloma Milla, Gema Cuthbertson, Brian Pappachan, John Klein, Nigel Mouncey, Paul Rowan, Kathy Myburgh, John Gouliouris, Theodore Baker, Stephen Parkhill, Julian Pathan, Nazima ARCTIC research team |
author_sort |
Kean, Iain Robert Louis |
title |
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
title_short |
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
title_full |
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
title_fullStr |
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
title_full_unstemmed |
Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study) |
title_sort |
short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the arctic study) |
publisher |
BMJ |
publishDate |
2024 |
url |
http://dx.doi.org/10.1136/gutjnl-2023-330851 https://syndication.highwire.org/content/doi/10.1136/gutjnl-2023-330851 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Gut volume 73, issue 6, page 910-921 ISSN 0017-5749 1468-3288 |
op_rights |
https://creativecommons.org/licenses/by/4.0/ |
op_doi |
https://doi.org/10.1136/gutjnl-2023-330851 |
container_title |
Gut |
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73 |
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6 |
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910 |
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921 |
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1802641653237809152 |