The effect of selective decontamination of the digestive tract on gastrointestinal enterococcal colonization in ITU patients.
OBJECTIVE
The effect of selective decontamination of the digestive tract (SDD) on Intensive Therapy Unit (ITU)-acquired enterococcal infection and colonization was studied. Changes in the predominant species isolated and resistance patterns to antimicrobial agents were also studied.


METHODS
Three groups were investigated: historical control (HC), contemporaneous control (CC) and patients receiving SDD (topical polymyxin, amphotericin B and tobramycin throughout ITU stay with intravenous ceftazidime for the first 3 days only).


METHODS
Adult general ITU with 7 beds.


METHODS
Patients with a nasogastric tube in situ and who were likely to remain in ITU for 48 h or longer were recruited.


RESULTS
Enterococcal infections occurred in 3 of 84 HC patients and 2 of 91 CC patients. There were no unit-acquired enterococcal infections in the SDD group. There were 140 episodes of enterococcal colonization occurring in 112 patients, with significantly more in the SDD and CC groups (p < 0.05. There were no significant differences in antibiotic sensitivities between the three groups. Enterococcus faecalis was the most frequently isolated species.


CONCLUSIONS
SDD does not predispose to enterococcal infection but does encourage colonization in patients receiving the regimen and other patients in ITU at the same. There is a complex interaction of factors which influence faecal flora and the likelihood of patients becoming colonized or infected with enterococci.
Humphreys
H
H
Department of Microbiology, Bristol Royal Infirmary, UK.
Winter
R
R
Pick
A
A
D000278:Administration, Buccal; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015984:Causality; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004064:Digestive System / Q000187:drug effects / Q000382:microbiology*; D004739:England / Q000453:epidemiology; D013293:Enterococcus faecalis; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents