The role of intestinal colonization with gram-negative bacteria as a source for intensive care unit-acquired bacteremia
| Autor: | Oostdijk, E.A., Smet, A.M. de, Kesecioglu, J., Bonten, M.J., Kalkman, C.J., Joore, H.C., Hoeven, J.G. van der, Pickkers, P., Sturm, P.D.J., Voss, A. |
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| Přispěvatelé: | RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Med Microbiol, Infect Dis & Infect Prev |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Resuscitation Cefotaxime Iron metabolism Pathogenesis and modulation of inflammation [IGMD 7] Colony Count Microbial DIGESTIVE-TRACT Oropharynx Bacteremia Critical Care and Intensive Care Medicine Gastroenterology THERAPY law.invention law Cluster Analysis Prospective Studies Infusions Intravenous Respiratory Tract Infections Netherlands intensive care Cross Infection SELECTIVE DECONTAMINATION NOSOCOMIAL INFECTIONS Incidence Ventilator-associated pneumonia Standard of Care Human decontamination decontamination Intensive care unit Gastroenteritis TRANSLOCATION Intestines Intensive Care Units medicine.anatomical_structure Treatment Outcome Female medicine.drug medicine.medical_specialty OVERGROWTH blood stream infection selective oropharyngeal decontamination Risk Assessment Drug Administration Schedule Microbiology Intensive care Internal medicine MOTILITY Gram-Negative Bacteria medicine Humans Proportional Hazards Models VENTILATOR-ASSOCIATED PNEUMONIA business.industry Pathogenesis and modulation of inflammation Infection and autoimmunity [N4i 1] medicine.disease selective digestive tract decontamination Gastrointestinal Tract decolonization business Gram-Negative Bacterial Infections Respiratory tract Follow-Up Studies |
| Zdroj: | Critical Care Medicine, 39(5), 961-966. LIPPINCOTT WILLIAMS & WILKINS Critical Care Medicine, 39, 961-6 Critical Care Medicine, 39, 5, pp. 961-6 |
| ISSN: | 1530-0293 0090-3493 |
| Popis: | Objective: Selective digestive tract decontamination aims to eradicate Gram-negative bacteria in both the intestinal tract and respiratory tract and is combined with a 4-day course of intravenous cefotaxime. Selective oropharyngeal decontamination only aims to eradicate respiratory tract colonization. In a recent study, selective digestive tract decontamination and selective oropharyngeal decontamination were associated with lower day-28 mortality, when compared to standard care. Furthermore, selective digestive tract decontamination was associated with a lower incidence of intensive care unit-acquired bacteremia caused by Gram-negative bacteria. We quantified the role of intestinal tract carriage with Gram-negative bacteria and intensive care unit-acquired Gram-negative bacteremia.Design: Data from a cluster-randomized and a single-center observational study.Setting: Intensive care unit in The Netherlands.Patients: Patients with intensive care unit stay of > 48 hrs that received selective digestive tract decontamination (n = 2,667), selective oropharyngeal decontamination (n = 2,166) or standard care (n = 1,945).Interventions: Selective digestive tract decontamination or selective oropharyngeal decontamination.Measurements and Main Results: Incidence densities (episodes/1000 days) of intensive care unit-acquired Gram-negative bacteremia were 4.5, 3.0, and 1.4 during standard care, selective oropharyngeal decontamination, and selective digestive tract decontamination, respectively, and the daily risk for developing intensive care unit-acquired Gram-negative bacteria bacteremia increased until days 36, 33, and 31 for selective digestive tract decontamination, standard care, and selective oropharyngeal decontamination and was always lowest during selective digestive tract decontamination. Rectal colonization with Gram-negative bacteria was present in 26% and 71% of patient days during selective digestive tract decontamination and selective oropharyngeal decontamination, respectively (p Conclusions: Respiratory tract decolonization was associated with a 33% and intestinal tract decolonization was associated with a 45% reduction in the occurrence of intensive care unit-acquired Gram-negative bacteremia. (Crit Care Med 2011; 39:961-966) |
| Databáze: | OpenAIRE |
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