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).

• Main Author: Pathan, Nazima
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ Publishing Group 2024
• Subjects: Arctic
• Online Access: https://www.repository.cam.ac.uk/handle/1810/363335; https://doi.org/10.17863/CAM.105447

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 to 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 multi-centre cluster-randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and inter-group 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 to children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared to standard care. SDD did not affect the composition of the oral microbiome compared to 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 to standard antimicrobial therapy.