Oropharyngeal Decontamination Research Articles

Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract

To compare the effects of two different antibiotic regimes on the colonization and infection rates of critically ill pediatric patients. A prospective randomized trial. A pediatric ICU in a university hospital. Fifty critically ill pediatric patients who required intensive care for at least 4 days were randomly allocated to either the selective parenteral and enteral antisepsis regimen (treatment group, n = 25) or the control group (n = 25). The treatment group received oral nonabsorbable antimicrobial agents (polymyxin E, gentamicin, and amphotericin B) and parenteral cefotaxime, whereas the control group received either perioperative antibiotic prophylaxis or antibiotic therapy according to clinical or microbiological evidence of infection. Both groups were comparable for age, body weight, sex, and severity of illness. Colonization with Gram-negative microorganisms and yeasts in the oropharynx, and digestive and respiratory tracts increased rapidly up to 52% in the control group, whereas there was no colonization with these microorganisms in the treatment group. The occurrence rates of acquired secondary infections in the control and treatment groups were 36% and 8%, respectively (p less than .025). There were no differences between groups in the duration of intensive care or mortality rate. Selective oropharyngeal and gastrointestinal decontamination combined with systemic cefotaxime application allows for a significant reduction of the colonization rate with Gram-negative bacteria and yeasts in critically ill pediatric patients undergoing prolonged intensive care. In addition, it significantly reduces the Gram-negative infection rate of the respiratory system. However, this therapeutic approach does not alter ICU length of stay or mortality rate.

Oral Decontamination and Ventilator-Associated Pneumonia

<h3>To the Editor.</h3> —Pugin et al¹reported that topical oropharyngeal decontamination with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride in patients requiring mechanical ventilation can greatly reduce the incidence of tracheobronchial colonization and pneumonia compared with a placebo administered in the same fashion. This is the latest in a series of studies that have demonstrated uniformly that the frequency of pneumonias acquired in the intensive care unit can be reduced by oropharyngeal, gastric, and occasionally, systemic antibiotics. This study has also added further confirmation to a growing body of evidence that while many critically ill patients die<i>with</i>pneumonia, they do not necessarily die<i>from</i>pneumonia. Despite a fivefold reduction in the risk of pneumonia in patients receiving oropharyngeal antibiotics, Pugin et al found no difference in the hospital mortality between patients who received oropharyngeal antibiotics and those who received oropharyngeal placebos. Similar data, with different antibiotic regimens,

Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial

Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial

The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients.

The incidence of respiratory tract infections was determined in 59 multiple trauma patients requiring prolonged intensive care (greater than 5 days) and receiving no antibiotic prophylaxis. Early pneumonia (less than 48 hr) with S. aureus, S. pneumoniae, and/or H. influenzae was found in 44% of patients. Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by pneumonia occurred in 12 patients (20%). The overall incidence of respiratory tract infections was 59%. In a prospective open trial three prophylactic antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable antibiotics (polymyxin E 400 mg, tobramycin 320 mg, amphotericin B 2,000 mg/day). No difference in infection rate was found. Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an ointment containing 2% of the same antibiotics. Secondary colonization and infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p less than 0.001). The incidence of early (Gram-positive) infections, however, was unchanged. Another group of 63 patients was treated with systemic antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination. The incidence of early pneumonia was significantly reduced (p less than 0.001). Five patients (8%) developed an infection. Superinfections were not observed.

Bed isolator for prevention of infection in bone marrow transplantation

It is difficult to make newly a laminar air flow room or to reconstruct a room for bone marrow transplantation. We placed a bed isolator in a room of pediatric ward and carried out bone marrow transplantation in 3 patients with acute leukemia. Intestinal and oropharyngeal decontamination was done using 3 drugs of vancomcin, tobramycin, amphotericin B, and strict bed isolator protection was carried out.Gut was decontaminated for aerobic as well as anaerobic bacteria, whereas candida albicans were difficult to eliminate in 1 case.In two patients, who had a difficulty to take oral medication and to carried out oropharyngeal nebulizer, suppression of oral microbial flora were not sufficient.During bed isolator protection, there were no febrile episode in 2 cases. In one patient, stomatitis and febrile episodes likely caused by oropharyngeal bacteria occurred, and these were well managed by using single antibiotics.It was suggested that bed isolator protection had a protective efficacy to prevent bacterial and fungal infection in bone marrow transplantation.

Oropharynx decontamination preventing Candida vegetation on voice prostheses.

Candida vegetations found in silicone voice prostheses used in postlaryngectomy voice rehabilitation are associated with prosthesis dysfunction. Selective oropharyngeal decontamination with amphotericin B lozenges resulted in sharp decrease of oropharyngeal Candida concentrations with a subsequent reduction of yeast colonization on voice prostheses and in tracheoesophageal fistula in ten patients. A case report suggests that this selective oropharyngeal decontamination can prolong the device's lifetime.

Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation.

During 1 year 27 patients admitted to the respiratory intensive care unit were monitored bacteriologically for a minimum of 10 days (mean: 26.7 days). Oropharyngeal swabs and tracheal aspirates were qualitatively and semi-quantitatively cultured twice weekly. A correlation between oropharyngeal and tracheal flora was found: once a bacterial species colonized the oropharyngeal cavity in high numbers, the identical microorganism was frequently isolated (greater than 50%) from the lower respiratory tract. Six of the 27 patients acquired an infection of the lower airways in the respiratory intensive care unit. The bacteria involved belonged to the patients oropharyngeal flora: S. aureus, Enterobacteriaceae and Pseudomonadaceae. As a result of this study showing the oropharynx to be the source of lower airway colonization/infection, a policy for infection prevention has been outlined. This policy is based on the concept of source elimination by means of oropharyngeal decontamination.