Introduction: The use of selective digestive decontamination (SDD) in critically ill patients remains controversial. The impact of antimicrobial resistance varies according to multiple factors attributed to the type of patient and the characteristics of intensive care units (ICU). Aim of the study: to describe the effect of the implementation of a selective digestive decontamination protocol on the incidence of nosocomial infections and colonization of multidrug-resistant organisms (MDRO) in an intensive care unit. Materials and methods: Prospective observational study in a general ICU of a University Hospital. All patients admitted for 2 years (divided into 1-year periods) before and after the implementation of the SDD were included. This intervention was performed in all patients who received invasive mechanical ventilation in the second period. Incidence density rates were determined for all nosocomial infections (per days of stay) and device-associated infections (per days of use), and risk ratio (RR) were calculated with 95% confidence intervals. Microbiological surveillance of the colonization status of patients was performed on admission and on a weekly basis. A univariate analysis was performed for comparison between groups. A p<0.05 was considered significant. Results: A total of 1532 patients were included in the pre-intervention period (pre-SDD) and 1734 in the post-intervention period (post-SDD). The incidence of all infections decreased [9.21 vs 6.54 per days of stay; RR: 0,71 (0,428 – 1,172), p=0,16], although not significantly. Both catheter-related bacteremias and all catheter-related bacteremias together (primary and secondary) were significantly reduced [4.49 vs 0.71 per 1000 days of use; RR: 0,157 (0,017 – 0,723), p=0,006]. The colonization rates by MDRO also decreased (3.26% vs 2.36%), but not significantly. Conclusions: Implementation of SDD significantly decreased the number of catheter-related bacteraemias, without an increase in MDRO colonization.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection predominantly affecting immunocompromised patients. Trimethoprim–sulfamethoxazole (TMP–SMX) remains the standard therapy but is often limited by severe toxicity. Rezafungin, a next-generation echinocandin with a long half-life, has shown preclinical activity against Pneumocystis spp., but its use in humans remains largely unexplored. We report the case of a 67-year-old man with inflammatory bowel disease who developed severe PJP complicated by acute respiratory failure, septic shock, and multiorgan dysfunction following corticosteroid and biologic therapy. Standard TMP–SMX therapy was contraindicated due to renal impairment and pancytopenia. The patient received rezafungin via a compassionate-use programme, with serial monitoring of serum and bronchoalveolar β-D-glucan levels. Despite a partial biomarker response, the patient ultimately progressed to refractory acute respiratory distress syndrome and multiorgan failure. This case provides preliminary human data suggesting that rezafungin may offer a potential therapeutic option for PJP when standard treatment is contraindicated or poorly tolerated. Close clinical and biomarker monitoring is essential. Further clinical and experimental studies are warranted to determine its efficacy, optimal dosing, and safety in critically ill immunocompromised patients.

The growing global threat of multidrug-resistant (MDR) bacteria has been exacerbated by inadequate antibiotic consumption and the difficulty in developing new therapeutic strategies. Selective Digestive Decontamination (SDD) is presented as an encouraging measure to prevent the appearance and colonization of MDR bacteria. We compared the pattern of antibiotic consumption in the Intensive Care Unit (ICU) of our hospital before and after the implementation of the SDD protocol. This quasi-experimental study was conducted in an ICU from June-2021 to June-2023. The incidence of nosocomial infections, colonizations, and the number of isolated MDR bacteria, as well as the defined-daily-dose (DDD), were monitored. A total of 3266 patients were included, with 1532 in the pre-intervention group and 1734 in the post-intervention group. The median age was 62 years, 66% were male, and the average APACHE II and SOFA scores were 15 and 6.5, respectively. There was a significant reduction in overall antibiotic consumption in the post-SDD group (p= 0.028), highlighting a decrease in Carbapenemase-Producing Enterobacteriaceae (CPE) (p= 0.0099). There was also a reduction in colonization incidence density and nosocomial infections. Implementing the SDD protocol significantly reduced antibiotic consumption in the ICU, suggesting important implications for infection control and antimicrobial resistance management.