Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

Antibiotic resistance, driven by the overuse of antibiotics, represents a huge threat to public health in Canada and worldwide. At the same time infections are a major cause of death for Canadians and significantly increases 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 reduce infections and prevent deaths is selective decontamination of the digestive tract (SDD), a preventative antibiotic regime. The evidence supporting the use of SDD for saving lives is reasonably strong but health care professionals have refrained from using SDD due to fears that increased use of antibiotics drives 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 before embarking on wider antibiotic use. In this study we plan to undertake- 1. A large-scale clinical trial examining the effect of antibiotics on the number of patients who die from infections. 2. A large study of antibiotic resistance patterns in modern ICUs including answering whether such antibiotics drive resistance The study of antibiotic resistance will be our key focus in Canada. If the benefits of this treatment are realized without driving antibiotic resistance, this study could have global impact through lives saved and infections prevented as well as reducing health care expenditure. The controversy surrounding SDD is such that only a definitive study is likely to resolve the debate, and without this study the opportunity to establish a life-saving measure as standard of care may be lost.