Decontamination Of Digestive Tract Research Articles

Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial

Patients with acute brain injury are at high risk of ventilator-associated pneumonia (VAP). The benefit of short-term antibiotic prophylaxis remains debated. We aimed to establish the effect of an early, single dose of the antibiotic ceftriaxone on the incidence of early VAP in patients with severe brain injury who required mechanical ventilation. PROPHY-VAP was a multicentre, randomised, double-blind, placebo-controlled, assessor-masked, superiority trial conducted in nine intensive care units in eight French university hospitals. We randomly assigned comatose (Glasgow Coma Scale score [GCS] ≤12) adult patients (age ≥18 years) who required mechanical ventilation for at least 48 h after acute brain injury to receive intravenous ceftriaxone 2 g or placebo once within the 12 h following tracheal intubation. Participants did not receive selective oropharyngeal and digestive tract decontamination. The primary outcome was the proportion of patients developing early VAP from the 2nd to the 7th day of mechanical ventilation, confirmed by masked assessors. The analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew or did not give consent to continue and those who did not receive the allocated treatment because they met a criterion for non-eligibility. The trial is registered with ClinicalTrials.gov, NCT02265406. From Oct 14, 2015, to May 27, 2020, 345 patients were randomly assigned (1:1) to receive ceftriaxone (n=171) or placebo (n=174); 330 received the allocated intervention and 319 were included in the analysis (162 in the ceftriaxone group and 157 in the placebo group). 166 (52%) participants in the analysis were men and 153 (48%) were women. 15 patients did not receive the allocated intervention after randomisation and 11 withdrew their consent. Adjudication confirmed 93 cases of VAP, including 74 early infections. The incidence of early VAP was lower in the ceftriaxone group than in the placebo group (23 [14%] vs 51 [32%]; hazard ratio 0·60 [95% CI 0·38-0·95], p=0·030), with no microbiological impact and no adverse effects attributable to ceftriaxone. In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation. French Ministry of Social Affairs and Health.

Carriage of antibiotic-resistant Gram-negative bacteria after discontinuation of selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD)

BackgroundSelective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) reduce colonization with antibiotic-resistant Gram-negative bacteria (ARGNB), incidence of nosocomial infections and improve survival in ICU patients. The effect on bacterial gut colonization might be caused by growth suppression by antibiotics during SDD/SOD. We investigated intestinal colonization with ARGNB after discharge from ICU and discontinuation of SDD or SOD.MethodsWe performed a prospective, observational follow-up study in regular hospital wards of three teaching hospitals in the Netherlands in patients discharged from the ICU, who were participating in a cluster randomized trial comparing SDD with SOD. We determined rectal carriage with ARGNB at ICU discharge (time (T) = 0) and 3, 6 and 10 days after discharge. The primary endpoint was time to first colonization with ARGNB that was not present at T = 0. Bacteria that are intrinsically resistant to antibiotics were not included in the primary analysis, but were included in post-hoc analysis.ResultsOf 1370 patients screened for inclusion, 996 patients had samples at T = 0 (507 after SDD and 489 after SOD). At ICU discharge, the prevalence of intestinal carriage with any ARGNB was 22/507 (4.3%) after SDD and 87/489 (17.8%) after SOD (p < 0.0001): 426 (SDD) and 409 (SOD) patients had at least one follow-up sample for analysis. The hazard rate for acquiring carriage of ARGNB after discontinuation of SDD, compared to SOD, in the ICU was 0.61 (95% CI 0.40–0.91, p = 0.02), and cumulative risks of acquisition of at least one ARGNB until day 10 were 13% (SDD) and 18% (SOD). At day 10 after ICU discharge, the prevalence of intestinal carriage with ARGNB was 11.3% (26/230 patients) after SDD and 12.5% (28/224 patients) after SOD (p = 0.7). In post-hoc analysis of all ARGNB, including intrinsically resistant bacteria, colonization at ICU discharge was lower after SDD (4.9 vs. 22.3%, p < 0.0001), but acquisition rates after ICU discharge were similar in both groups.ConclusionsIntestinal carriage at ICU discharge and the acquisition rate of ARGNB after ICU discharge are lower after SDD than after SOD. The prevalence of intestinal carriage with ARGNB at 10 days after ICU discharge was comparable in both groups, suggesting rapid clearance of ARGNB from the gut after ICU discharge.Trial registrationNetherlands Trial Registry, NTR3311. Registered on 28 february 2012.

Su1304 - Effect of Preoperative Selective Decontamination of the Digestive Tract (SDD) and Mechanical Bowel Preparation (MBP) on Postoperative Ileus in Mice

Su1304 - Effect of Preoperative Selective Decontamination of the Digestive Tract (SDD) and Mechanical Bowel Preparation (MBP) on Postoperative Ileus in Mice

Toxic tobramycin levels after Tobramycin intake via selective decontamination of the digestive tract (SDD)

Toxic tobramycin levels after Tobramycin intake via selective decontamination of the digestive tract (SDD)

Decolonization and decontamination: what's their role in infection control?

Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures. Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries. Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.

Fighting antibiotic resistance in the intensive care unit using antibiotics.

Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

Selective decontamination of the digestive tract: What outcomes matter?*

Selective decontamination of the digestive tract: What outcomes matter?*

Reducing susceptibility to bacteremia after experimental burn injury: a role for selective decontamination of the digestive tract

Reducing susceptibility to bacteremia after experimental burn injury: a role for selective decontamination of the digestive tract

Selective Digestive-Tract Decontamination in Trauma Patients, Revisited

In 1983, Stoutenbeek and colleagues introduced selective decontamination of the digestive tract (SDD) as a way to prevent infection in intensive care

The efficiency of selective decontamination of the digestive tract for the treatment of children with MODS

目的 研究选择性肠道去污(SDD)对小儿MODS的防治效果.方法2004年4月～2005年6月在ICU住院的符合MODS诊断的患儿60名,随机分成常规治疗组M1组(30名),常规治疗+口服庆大治疗(SDD)M2组(30名),分析研究治疗前、后两组患儿的血清炎症介质的变化、并发症的发生率和病死率.结果M1组在ICU的平均住院时间为(14.68±4.8)d,M2组为(9.69±1.56)d,(P＜0.05);M1组出现感染并发症的人数多于M2组;M2组患儿中性粒细胞计数在治疗期间下降更为明显;M1组患儿血清TNF浓度在治疗前、后没有显著变化,M2组血清TNF浓度在治疗后明显降低.结论选择性肠道去污的治疗能有效减轻并发症,缩短病程,能否降低病死率有待进一步探讨。

Selective Digestive Tract Decontamination Deemed Unhelpful

Controversies exist regarding selective decontamination of the digestive tract (SDD) and its impact on clinical outcomes and bacterial resistance

Prospective study of bacteraemia in cancer patients. Results of a French multicentre study.

We performed a prospective assessment of the current epidemiology of bacteraemia in cancer patients hospitalized in 70 different adult and paediatric haematology and oncology departments. Over a 1-month period, microbiologists from 54 hospitals collected clinical data relating to patients with at least one positive blood culture. In addition, all strains isolated were assessed for their in vitro susceptibility to three broad-spectrum cephalosporins suitable for empirical treatment in cancer patients: cefpirome, cefepime and ceftazidime. A total of 494 different strains were isolated from 1,038 blood cultures taken from 403 different patients. Seventeen strains were isolated from 13 patients with various nonmalignant diseases, and these cases were excluded from analysis. Overall, 330 (69.2%) of the strains were isolated in patients with haematological malignancy and 147 (30.8%), in patients with solid tumours. There was no difference in the distribution of the species involved in bacteraemia between patients with haematological malignancy and patients with solid tumours: coagulase-negative staphylococci were the leading pathogens (50.6% and 44.9%, respectively), followed by E. coli (11.2% and 12.2% respectively), S. aureus (6.3% vs 7.5%), streptococci (4.8% vs 5.4%) and P. aeruginosa (5.2% vs 4.8%). All other species accounted for less than 5% in both groups. There was no difference in the strain distribution with age (> or = 15 years vs < 15 years) or type of underlying disease. S. aureus and Enterobacteriaceae bacteraemia were more frequent in patients with end-stage disease, while oral streptococci, Enterobacteriaceae and P. aeruginosa infections were more frequent in patients who were severely neutropenic. Digestive tract decontamination was associated with increased frequency of oral streptococci and decreased frequency of Enterobacteriaceae infections. All three cephalosporins demonstrated similar activity against E. coli, while cefpirome and cefepime appeared to be more effective against other Enterobacteriaceae. Ceftazidime had better activity against P. aeruginosa. Cefpirome was the most effective against Gram-positive cocci, especially oral streptococci and methicillin-susceptible staphylococci.

Short-term impact of the European Consensus Conference on the use of selective decontamination of the digestive tract with antibiotics in ICU patients

Short-term impact of the European Consensus Conference on the use of selective decontamination of the digestive tract with antibiotics in ICU patients

Selective decontamination of the digestive tract: 13 years on, what it is and what it is not

Selective decontamination of the digestive tract: 13 years on, what it is and what it is not

Fluoroquinolones show potential in the ICU setting

Fluoroquinolones may provide a useful tool for tackling the growing problem of nosocomial infections in the ICU. This class of antibacterials offers many advantageous properties for use in selective decontamination of the digestive tract and, indeed, fluoroquinolone-containing regimens have been shown to provide protection against infection in this setting. This approach, and other issues relating to fluoroquinolone use in the ICU, were discussed at the 5th International Symposium on New Quinolones [Singapore; August 1994].

Selective decontamination of the digestive tract as an infection-control measure in intensive care unit patients.

Infection is responsible for a large percentage of morbidity and mortality in intensive care unit (ICU) patients. Conventional infection-control measures are directed at decreasing infection by exogenous sources and have had variable success in significantly reducing nosocomial infection rates. Selective gastrointestinal decontamination with topical nonabsorbable antibiotics attempts to reduce infection by eliminating intestinal mucosal colonization by pathogenic microorganisms. These antibiotics are selectively bactericidal against gram-negative organisms and yeasts, thereby leaving the normal flora (mainly anaerobes) unharmed. In the majority of clinical trials, selective decontamination effectively reduced colonization and infection among ICU patients, with the most significant reductions observed in gram-negative respiratory infections. Resistance to the antimicrobials was not documented in the majority of trials; however, follow-up periods were minimal and may not have been adequate to detect selection of resistant strains. Reductions in infection do not alter mortality; however, patients without significant underlying disease appear to be the subgroup that will most likely benefit.

Selective Decontamination of the Digestive Tract

Selective Decontamination of the Digestive Tract

Selective decontamination of the digestive tract

Selective decontamination of the digestive tract (SDD) is an infection prevention technique used in granulocytopenic patients, transplantation surgery and in critically ill intensive care patients. It is based on the observation that many infections are caused by aerobic gram-negative bacteria (Enterobacteriaceae and Pseudomonadaceae), Staphylococcus aureus and yeast spp. carried in the oropharyngeal or intestinal flora (i.e. endogenous infections). It is called selective because the topical antibiotics used for SDD have little effect on the indigenous flora. The indigenous mostly anaerobic flora should be preserved as much as possible because it has important physiological functions and is seldom the cause of infection. More than 10 years after the introduction of SDD in intensive care [1] it is still controversial. In this chapter, the rationale for SDD in intensive care patients and the controversial issues will be discussed.

The place of selective decontamination in intensive care

Selective decontamination of the digestive tract means the abolition of the oropharyngeal and gastrointestinal carriage of only disease-causing microorganisms. The abolition of the carrier state by topical, non-absorbable antimicrobials (polymyxin E, tobramycin, amphotericin B) is associated with clinical (prevention of secondary endogenous infections), bacteriological (control of resistance) and epidemiological (outbreak control) benefits. The 22 trials published so far are reviewed and discussed.

Intraabdominal infection: Pulmonary failure

Since its first description in 1967, the mortality of the adult respiratory distress syndrome (ARDS) has remained unchanged despite the increasing sophistication of supportive techniques. Few patients now die of refractory hypoxemia, the majority succumbing to the multiple systems organ failure syndrome, commonly due to sepsis. Sepsis is both the most common cause of ARDS, usually involving the abdomen, and the most frequent complication, usually affecting the lungs. ARDS is, thus, increasingly seen as the pulmonary component of multiple systems organ failure, triggered by the systemic response to sepsis. In critically ill patients, impairment of hepatic function and of the barrier function of the gut mucosa allows translocation of endotoxin derived from the aerobic Gram-negative bacteria within the gut. This releases mediators which are responsible for the activation of cellular and humoral cascades, resulting in the pathological changes seen in ARDS. This sequence of events underlines the importance of therapies directed at abnormal colonization of the gastrointestinal tract and elimination of the gut endotoxin pool. Selective decontamination of the digestive tract is attractive in that it attacks the problem from 2 sides: first, by eliminating colonization, it appears effective in preventing secondary infection and, second, it may also play a role in reducing the enteric endotoxin pool. Recent descriptions of pathological oxygen supply dependency in both ARDS and septic patients emphasize the similarity of pathophysiological abnormalities in the 2 conditions. Intensive supportive therapy to achieve adequate oxygen transport and aggressive investigation and surgical management of septic foci are the cornerstones of management of the established syndrome.