Selective decontamination of the gastrointestinal tract as an infection control measure.
An outbreak caused by a Klebsiella aerogenes resistant to ceftazidime, cefuroxime, cefotaxime, ampicillin and piperacillin and sensitive to aminoglycosides, imipenem and temocillin occurred in a teaching hospital's busy multi-disciplinary Intensive Care Unit over a 3-month period. Four patients had bacteraemia and a further four were colonized. Traditional infection control measures failed to eradicate the outbreak. The introduction of a selective gastrointestinal decontamination regimen consisting of tobramycin, amphotericin and colistin as a gel to the oropharynx, nose and rectum and a suspension via a nasogastric tube resulted in rapid disappearance of the outbreak strain with no new isolates being detected clinically or in surveillance specimens over an 8-week period.
Department of Microbiology, Withington Hospital, Manchester.
M E
ME
Taylor
B A
BA
Oppenheim
D000666:Amphotericin B / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D004196:Disease Outbreaks; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000382:microbiology; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D014031:Tobramycin / Q000627:therapeutic use
D000666:Amphotericin B; D014031:Tobramycin; D003091:Colistin