Selective Intestinal Decontamination-An Infection Control Measure Whose Time Has Come?
Authors: Robert A. Weinstein
Journal: Annals of Internal Medicine (1989)

Editorials1 June 1989Selective Intestinal Decontamination-An Infection Control Measure Whose Time Has Come?Robert A. Weinstein, MDRobert A. Weinstein, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-11-853 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn this issue, Brun-Buisson and coworkers (1) report the use of oral antibiotics for intestinal decontamination in an outbreak of infection with multiply-resistant Enterobacteriaceae (predominantly Klebsiella species) in a French medical intensive care unit. They found that patients in the study had less intestinal colonization and infection with the epidemic strains than historical and concurrent controls; however, decontamination produced no beneficial effect on overall rates of nosocomial infection in the unit.The use of oral, nonabsorbable antibiotics for selective tive decontamination in endemic and hyperendemic gram-negative bacillary infections in intensive care units has been evaluated for almost 20 years (2-7)....References1. Brun-Buisson C, Legrand P, and Rauss A. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med. 1989;110:873-881. LinkGoogle Scholar2. Feeley T, Du Moulin G, Hedley-Whyte J, Bushnell L, Gilbert J, and Feingold D. Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med. 1975;193:471-5. CrossrefGoogle Scholar3. Klastersky J, Hensgens C, Noterman J, Mouawad E, and Meunier-Carpentier F. Endotracheal antibiotics for the prevention of tracheobronchial infections in tracheotomized unconscious patients. A comparative study of gentamicin and aminosidin-polymyxin B combination. Chest. 1975;68:302-6. CrossrefMedlineGoogle Scholar4. Stoutenbeek C, van Saene H, Miranda D, Zandstra D, and Langrehr D. Nosocomial gram-negative pneumonia in critically ill patients. A 3-year experience with a novel therapeutic regimen. Intensive Care Med. 1986;12:419-23. CrossrefMedlineGoogle Scholar5. Unertl K, Ruckdeschel G, and Selbmann H. Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med. 1987;13:106-13. CrossrefMedlineGoogle Scholar6. Ledingham I, Alcock S, Eastaway A, McDonald J, McKay I, and Ramsay G. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet. 1988;1:785-90. CrossrefMedlineGoogle Scholar7. Flaherty J, Nathan C, Kabins S, and Weinstein R. Nonabsorbable antibiotics vs. sucralfate in preventing colonization and infection in a cardiac surgery ICU [Abstract 28]. In: Program and Abstracts, 28th Interscience Conference on Antimicrobial Agents and Chemotherapy. Los Angeles: American Society for Microbiology; 1988. Google Scholar8. Schaberg D, Weinstein R, and Stamm W. Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: epidemiology and control. J Infect Dis. 1976;133:363-6. CrossrefMedlineGoogle Scholar9. Weinstein R and Kabins S. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med. 1981; 70:449-54. CrossrefMedlineGoogle Scholar10. Weinstein R. Multiply resistant strains: epidemiology and control. In: Bennett JV, Brachman PS, eds. Hospital Infections. 2d ed. Boston: Little, Brown; 1986:151-69. Google Scholar11. Flynn D, Weinstein R, Nathan C, Gaston M, and Kabins S. Patients' endogenous flora as the source of "nosocomial" Enterobacter in cardiac surgery. J Infect Dis. 1987;156:363-8. CrossrefMedlineGoogle Scholar12. Olson B, Weinstein R, Nathan C, Chamberlin W, and Kabins S. Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis. 1984;150:808-16. CrossrefMedlineGoogle Scholar13. Driks M, Craven D, and Celli B. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987;317:1376-82. CrossrefMedlineGoogle Scholar14. Clasener H, Vollaard E, and van Saene H. Long-term prophylaxis of infection by selective decontamination in leukopenia and in mechanical ventilation. Rev Infect Dis. 1987;9:295-328. CrossrefMedlineGoogle Scholar15. Stoutenbeek C, van Saene H, Miranda D, and Zandstra D. A new technique of infection prevention in the intensive care unit by selective decontamination of the digestive tract. Acta Anaesthesiol Belg. 1983;3:209-21. Google Scholar16. Weisser J and Wiedemann B. Elimination of plasmids by new 4-quinolones. Antimicrob Agents Chemother. 1985;28:700-2. CrossrefMedlineGoogle Scholar17. Stoutenbeek C, van Saene H, and Zandstra D. The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother. 1987;19:513-20. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Robert A. Weinstein, MDAffiliations: Michael Reese Hospital and Medical Center Chicago, Illinois Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAll great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truthProphylaxis with enteral antibiotics in ventilated patients: selective decontamination or selective cross-infection?Chemoprophylaxis for the prevention of bacterial and fungal infectionsOrgan-specific support in multiple organ failure: Pulmonary supportSelective Decontamination of the Digestive TractImpact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated PneumoniaThe value of new antimicrobial agentsUse of Selective Decontamination of the Digestive Tract Is the Light at the End of the Tunnel Red or Green?Donald E. Craven, MDNosocomial Respiratory Tract Infections in Multiple Trauma PatientsMultiple Organ Failure Syndrome—Part II: Prevention and TreatmentPrevention of Infection by Gramnegative MicroorganismsEpidemiology and control of nosocomial infections in adult intensive care unitsFailure of infection control in intensive care units: Can sucralfate improve the situation?Selective decontamination of the digestive tract (SDD) in intensive care patients: a critical evaluation of the clinical, bacteriological and epidemiological benefitsComplications Associated with Mechanical VentilationSelective Gut Decontamination in Ventilated PatientsReview of available trials of selective decontamination of the digestive tract (SDD)Selective decontamination of the digestive tract. 1 June 1989Volume 110, Issue 11 Page: 853-855 Keywords Antibiotics Decontamination Enterobacter infections Enterobacteriaceae Hospital medicine Intensive care units Interleukins Klebsiella Medical intensive care units Nosocomial infections ePublished: 1 December 2008 Issue Published: 1 June 1989 PDF downloadLoading ...