Association between selective digestive decontamination and decreased rate of acquired candidemia in mechanically ventilated ICU patients: a multicenter nationwide study
Authors: Reizine Florian , Massart Nicolas , Joussellin Vincent , Machut Anaïs , Vacheron Charles-Hervé , Savey Anne , Friggeri Arnaud , Lepape Alain ,   the REAREZO study group, Alfandari Serge , Allaire Alexandra , Alvarez Antonio , Nacim Ammenouche , Argaus Laurent , Audibert Gérard , Aurel Caroline , Bajolet Odile , Barbut Frédéric , Barjon Genevieve , Baune Patricia , Beague Sébastien , Beilouny Bassam , Bele Nicolas , Belin Nicolas , Bernerd Cécile , Berrouane Yasmina , Berrouba Aziz , Bertrand Julie , Bianchi Claire , Biangoma Sandrine , Jaulin Fabienne Birot , Bonjean Severine , Bordes-Couecou Stéphanie , Bouhara Abdenour , Bouillard Philippe , Bourigault Céline , Bourzeix Sylvie , Boutreux Sébastien , Bouzidi Hanene , Brochart Julie , Bulyez Stéphanie , Callanquin Marie , Canu Nathalie , Capron Matthieu , Carbognani Daniel , Castelain Vincent , Catanese Vincent , Cattaneo Isabelle , Chartier Vanessa , Chassaing Guillaume , Chausset Robert , Chauvet Mélanie , Chopin Fabrice , Chubilleau Catherine , Clayer Céline , Cohen Agnès , Comparot Sylvie , Corne Philippe , Cornesse Marie-Elisabeth , Corno Gaelle , Cortes Esther , Courouble Patricia , Crombe Christian , Curnier Véronique , Dabbachi Monzer , Dananché Cédric , Daroukh Abla , Dassant Damien , Daumas Martine , Daurat Aurélien , Deffarges Dominique , Delanghe Fanny , Delastre Olivier , Delhomme Joel , Délias Jean Paul , Delorme Martine , Derramond Fabienne , Diaw Frédérique , Dijols Isabelle , Djedaini Kamel , Dopeux Loic , Duhoo Sophie , Dulac Thierry , Dupin Clarisse , Dupont Laurène , Durand Michel , Joly Isabelle Durand , Dusseau Jean-Yves , Egreteau Pierre Yves , Eldin Carole , Espinasse Florence , Farfour Eric , Fatah Abdelhamid , Fedun Yannick , Ferreira Luis , Fillatre Pierre , Finge Toufic , Fleurial Véronique , Florentin Arnaud , Fribourg Agnès , Gallais-Hoff Severine , Galland Claude , Galliot Richard , Garnier Sylvain , Gasan Gaelle , Gaubert-Duclos Julien , Gauzere Valérie , Geffriaud Thomas , Geneau Isabelle , Georges Hughes , Colomban Solweig Gerbier , Giacardi Christophe , Gibot Sebastien , Glanard Audrey , Gleize Marion , Goret Marieline , Gourgues Michele , Grau Delphine , Grisi Béatrice , Groleau Clotilde , Grolier-Bois Liliane , Guignabert Catherine , Hadj-Slimane Fethi , Hammad Emmanuelle , Haond Catherine , Hausermann Marie Hélène , Hayo Francoise , Henry Christophe , Herbland Alexandre , Huntzinger Julien , Hyvernat Hervé , Jean Alexandre , Jolibois Boris , Joron Sylvie , Julien Gauthier , Kempf Jean , Knani Lyes , La Combe Béatrice , Labruyere Marie , Lacroix Sandrine , Lafon Bruno , Lamant Katia , Larroudé Peggy , Launoy Anne , Laurent Bernadette , Lavigne Thierry , Lawrence Christine , Le Quoc Vien , Le Coq Muriel , Le Floch Anne-Sophie , Le Fall Fanny , Le Tallec Brigitte , Lecoutre Lucie , Ledochowski Stanislas , Leon Rusel , Lepouse Claire , Lescot Thomas , Levrard Mélanie , Lier Marie Laure , Lignereux Anne , Louart Benjamin , Maheu Claire , Maindron Aurélie , Mallard Francois , Mallaret Marie Reine , Mankikian Bernard , Manzon Christiane , Mardrus Philippe , Mariot Jacques , Martin Audry , Martin Emmanuelle , Martin Maelle , Martres Pascale , Maxime Virginie , Meunier Olivier , Meyer Ella-Pauline , Meziani Ferhat , Moschietto Sébastien , Muller Céline , Munier-Marion Elodie , Neulier Caroline , Nicolas François , Nizou Jacques-Yves , Palitta Christine , Pascal Michel , Passouant Olivier , Patrigeon René-Gilles , Pavillard Frédérique , Peghaire Sabine , Perdrix Christophe , Petit Jean-Sebastien , Pibre Judith , Picard Walter , Picault Sylvie , Gil Santiago Picos , Pillot Jérôme , Pina Patrick , Plattier Rémi , Poiron Laurent , Pommier Christian , Pradel Gaël , Prelipcean Cristian , Pugliesi Paul-Simon , Quenee Vincent , Raposo Olga , Remy Eve , Deforges Sabine Reynaud , Richard Jean-Christophe , Ricome Sylvie , Rimmele Thomas , Robine Adrien , Roche Anne-Claude , Rohr Laetitia , Rolland-Jacob Gwenaël , Roques Adrien , Rougier Catherine , Roustan Jérôme , Saint-Leger Mélanie , Saliba Faouzi , Sechaud Dominique , Si-Ali Amine , Simac Catherine , Simon Georges , Sirodot Michel , Stoeckel Vincent , Tagawa Philippe , Tasle Marine , Thiollière Fabrice , Thiphagne Benoit , Thomas-Hervieu Aurélie , Tinturier François , Tonnelier Alexandre , Toro Alexandre , Tranvan David , Trivier Dominique , Troché Gilles , Trusson Rémi , Ursulet Lionel , Valdeyron Marie Laure , Vallet Catherine , Van Rossem Vanessa , Vasse Laurence , Venelle Myriam , Venot Christine , Vieillard-Baron Antoine , Vincent Jean-François , Vitris Michel , Yassine Hussein , Zanre Lassane , Zylberfajn Cecile 
Published: December 2023

Abstract
Background
Candidemia is a high-risk complication among intensive care unit (ICU) patients. While selective digestive decontamination (SDD) has been shown to be effective in preventing ICU-acquired bacterial secondary infection, its effects on ICU-acquired candidemia (ICAC) remain poorly explored. Therefore, we sought to assess the effects of SDD on ICAC.

Method
Using the REA-REZO network, we included adult patients receiving mechanical ventilation for at least 48 h from January 2017 to January 2023. Non-parsimonious propensity score matching with a 1:1 ratio was performed to investigate the association between SDD and the rate of ICAC.

Results
A total of 94 437 patients receiving at least 48 h of mechanical ventilation were included throughout the study period. Of those, 3 001 were treated with SDD and 651 patients developed ICAC. The propensity score matching included 2 931 patients in the SDD group and in the standard care group. In the matched cohort analysis as well as in the overall population, the rate of ICAC was lower in patients receiving SDD (0.8% versus 0.3%; p = 0.012 and 0.7% versus 0.3%; p = 0.006, respectively). Patients with ICAC had higher mortality rate (48.4% versus 29.8%; p < 0.001). Finally, mortality rates as well as ICU length of stay in the matched populations did not differ according to SDD (31.0% versus 31.1%; p = 0.910 and 9 days [5–18] versus 9 days [5–17]; p = 0.513, respectively).

Conclusion
In this study with a low prevalence of ICAC, SDD was associated with a lower rate of ICAC that did not translate to higher survival.