Selective decontamination of the digestive tract contributes to the control of disseminated intravascular coagulation in severe liver impairment.
A premature neonate with severe Coxsackie B1 hepatitis acquired in utero developed disseminated intravascular coagulation a few days after birth. The neonate did not respond to conventional treatment. Eradication of aerobic gram-negative bacilli (Enterobacteriaceae) from the gut with oral nonabsorbable polymyxin E and tobramycin (selective decontamination of the digestive tract) was followed by clinical improvement; disseminated intravascular coagulation was controlled. After an unstable convalescence, the neonate recovered and was discharged in good general condition. A correlation between oral feeding, gut carriage of Enterobacteriaceae, fecal endotoxin pool, and platelet counts was observed. The eradication of gut carriage of aerobic gram-negative bacilli was associated with a significant decrease of the intestinal endotoxin pool and paralleled the recovery from thrombocytopenia. Selective decontamination is discussed as a method of possible value for controlling systemic endotoxin-induced symptoms in the critically ill with intestinal endotoxemia.
van Saene
H K
HK
Department of Clinical Bacteriology, University of Groningen, The Netherlands.
Stoutenbeek
C P
CP
Faber-Nijholt
R
R
van Saene
J J
JJ
D000284:Administration, Oral; D002444:Cefuroxime / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use*; D003384:Coxsackievirus Infections / Q000150:complications*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control*; D029822:Enterovirus B, Human; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D007422:Intestines / Q000382:microbiology*; D014031:Tobramycin / Q000627:therapeutic use*
D002444:Cefuroxime; D014031:Tobramycin; D003091:Colistin