Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit.
OBJECTIVE
To study the efficacy of intestinal decontamination by oral nonabsorbable antibiotic agents to control a nosocomial outbreak of intestinal colonization and infection with multiresistant Enterobacteriaceae, and to examine its effects on endemic nosocomial infection rates.


METHODS
A 10-week prospective incidence study (group 1), and then an 8-week randomized, open trial of intestinal decontamination (groups 2 and 3).


METHODS
A medical intensive care unit of a tertiary care university hospital.


METHODS
Consecutive patients with unit stay of over 2 days and a severity score at admission of more than 2; 124 patients were included in group 1, 50 in group 2 (control), and 36 in group 3 (intestinal decontamination).


METHODS
Neomycin, polymyxin E, and nalidixic acid were given to group 3 patients throughout their stay in the unit.


RESULTS
Intestinal colonization with multiresistant strains occurred in 19.6% of patients in group 1, at a mean of 16 days after admission, and preceded detection in clinical samples by a mean of 11 days. During the decontamination trial, intestinal colonization rates decreased to 10% (group 2), and 3% (group 3) (P = 0.12 and P less than 0.01, compared with group 1, respectively). Corresponding infection rates were 9% (group 1), 3% (group 2), and 0 (group 3). No new cases were detected in the following 4 months. The intestinal colonization rate with gram-positive cocci was higher in group 3 than group 2 (P less than 0.001). The overall rate of nosocomial infections was at 28% (group 1), 33% (group 2), and 32% (group 3).


CONCLUSIONS
Intestinal decontamination can help to control an outbreak of intestinal colonization and infection with multiresistant gram-negative bacilli in the intensive care unit, but should not be recommended for routine prevention of endemic nosocomial infections.
Brun-Buisson
C
C
Hôpital Henri Mondor, Creteil, France.
Legrand
P
P
Rauss
A
A
Richard
C
C
Montravers
F
F
Besbes
M
M
Meakins
J L
JL
Soussy
C J
CJ
Lemaire
F
F
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002511:Cephalosporins / Q000494:pharmacology; D003091:Colistin / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004755:Enterobacteriaceae / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D007422:Intestines / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008875:Middle Aged; D009268:Nalidixic Acid / Q000627:therapeutic use; D009355:Neomycin / Q000627:therapeutic use; D010297:Paris; D011897:Random Allocation; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D009268:Nalidixic Acid; D009355:Neomycin; D003091:Colistin