Ecological effects of selective decontamination on resistant gram-negative bacterial colonization

Autor: Robin F. J. Benus, Emily S. Thieme Groen, Jan Kluytmans, Maurine A. Leverstein-van Hall, Ellen M. Mascini, Wouter Pauw, Ine H. M. E. Frenay, Bartelt M. de Jongh, Steven F. T. Thijsen, Gerard J. van Asselt, Hetty E. M. Blok, Marc J. M. Bonten, Jansz A, Evelien A. N. Oostdijk, J. A. Kaan, Patrick D. J. Sturm, Sandra A. T. Bernards, Anne Marie G. A. de Smet
Přispěvatelé: Medical Microbiology and Infection Prevention, CCA - Immuno-pathogenesis, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
Rok vydání: 2010
Předmět:
Zdroj: American Journal of Respiratory and Critical Care Medicine, 181(5), 452-457. American Thoracic Society
American Journal of Respiratory and Critical Care Medicine, 181, 452-7
American Journal of Respiratory and Critical Care Medicine, 181(5), 452-457
American Journal of Respiratory and Critical Care Medicine, 181(5), 452-457. AMER THORACIC SOC
American Journal of Respiratory and Critical Care Medicine, 181, 5, pp. 452-7
Oostdijk, E A N, De Smet, A M G A, Blok, H E M, Groen, E S T, van Asselt, G J, Benus, R F J, Bernards, S A T, Frenay, I H M E, Jansz, A R, de Jongh, BM, Kaan, J A, Leverstein-van Hall, M A, Mascini, EM, Pauw, W, Sturm, P D J, Thijsen, S F T, Kluijtmans, J A J W & Bonten, M J M 2010, ' Ecological Effects of Selective Decontamination on Resistant Gram-negative Bacterial Colonization ', American Journal of Respiratory and Critical Care Medicine, vol. 181, no. 5, pp. 452-457 . https://doi.org/10.1164/rccm.200908-1210OC
ISSN: 1073-449X
Popis: Contains fulltext : 88783.pdf (Publisher’s version ) (Closed access) RATIONALE: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) eradicate gram-negative bacteria (GNB) from the intestinal and respiratory tract in intensive care unit (ICU) patients, but their effect on antibiotic resistance remains controversial. OBJECTIVES: We quantified the effects of SDD and SOD on bacterial ecology in 13 ICUs that participated in a study, in which SDD, SOD, or standard care was used during consecutive periods of 6 months (de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, et al. N Engl J Med 2009;360:20-31). METHODS: Point prevalence surveys of rectal and respiratory samples were performed once monthly in all ICU patients (receiving or not receiving SOD/SDD). Effects of SDD on rectal, and of SDD/SOD on respiratory tract, carriage of GNB were determined by comparing results from consecutive point prevalence surveys during intervention (6 mo for SDD and 12 mo for SDD/SOD) with consecutive point prevalence data in the pre- and postintervention periods. MEASUREMENTS AND MAIN RESULTS: During SDD, average proportions of patients with intestinal colonization with GNB resistant to either ceftazidime, tobramycin, or ciprofloxacin were 5, 7, and 7%, and increased to 15, 13, and 13% postintervention (P < 0.05). During SDD/SOD resistance levels in the respiratory tract were not more than 6% for all three antibiotics but increased gradually (for ceftazidime; P < 0.05 for trend) during intervention and to levels of 10% or more for all three antibiotics postintervention (P < 0.05). CONCLUSIONS: SOD and SDD have marked effects on the bacterial ecology in an ICU, with rising ceftazidime resistance prevalence rates in the respiratory tract during intervention and a considerable rebound effect of ceftazidime resistance in the intestinal tract after discontinuation of SDD.
Databáze: OpenAIRE
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