+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Selective digestive tract decontamination--will it prevent infection with multidrug-resistant gram-negative pathogens but still be applicable in institutions where methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci are endemic?



Selective digestive tract decontamination--will it prevent infection with multidrug-resistant gram-negative pathogens but still be applicable in institutions where methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci are endemic?



Clinical Infectious Diseases 43(Suppl. 2): S70



The purposes of selective decontamination of the digestive tract are to treat infections that may be incubating at the time a patient is admitted to an intensive care unit (ICU), by intravenous administration of antibiotics during the first days of a stay in the ICU, and to prevent ICU-acquired infections, by topical application of antibiotics in the oropharynx and the gastrointestinal tract. Despite multiple trials in which a considerable reduction in the incidence of ventilator-associated pneumonia was demonstrated, major objections against the routine use of selective decontamination of the digestive tract have included a lack of demonstrated reductions in mortality rates and in length of stay (in individual trials), a lack of cost-efficacy data, and the threat of selection of multidrug-resistant bacteria. Recently, 2 controlled, randomized studies reported significant reductions in mortality rates among patients in ICUs who underwent selective decontamination of the digestive tract in combination with reduced selection of antibiotic-resistant pathogens. However, those studies were performed in settings where levels of antibiotic resistance are low, and some methodological issues remain unresolved. If these beneficial results are confirmed, the question of how to balance these benefits against the expected enhanced selection of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and, possibly, multidrug-resistant gram-negative bacteria will emerge.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 050272659

Download citation: RISBibTeXText

PMID: 16894518

DOI: 10.1086/504482


Related references

Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Critical Care Medicine 31(4): 1175-1182, 2003

Natural history of colonization with vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term-care facility residents. Infection Control and Hospital Epidemiology 24(4): 246-250, 2003

Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus. Medical Clinics of North America 90(6): 1165-1182, 2006

Arbekacin: another novel agent for treating infections due to methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative pathogens. Clinical Pharmacology 6: 139-148, 2014

Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci. Mayo Clinic Proceedings 86(12): 1230-1243, 2011

Current Concepts in Antimicrobial Therapy Against Select Gram-Positive Organisms Methicillin-Resistant Staphylococcus aureus, Penicillin-Resistant Pneumococci, and Vancomycin-Resistant Enterococci. 2011

Recent antibiotic resistance patterns and prevalence of methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, and vancomycin-resistant enterococci from bovine mastitis in Korea (2003-2005). 2006

Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and other Gram-positives in healthcare. Current Opinion in Infectious Diseases 25(4): 385-394, 2012

The Importance of Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. JAMA 319(9): 863-864, 2018

Effect of Cessation of Contact Isolation for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. Infection Control and Hospital Epidemiology 38(8): 1005-1007, 2017

Independent risk factors for the co-colonization of vancomycin-resistant Enterococcus faecalis and methicillin-resistant Staphylococcus aureus in the region most endemic for vancomycin-resistant Staphylococcus aureus isolation. European Journal of Clinical Microbiology and Infectious Diseases 32(6): 815-820, 2013

Activity of daptomycin compared to linezolid against vancomycin-resistant enterococci , methicillin-resistant Staphylococcus aureus , and glycopeptide-intermediate Staphylococcus aureus in an in vitro infection model. Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy 41: 29, 2001

Predicting methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci infection upon hospital admission. Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy 43: 386, 2003

Hospital infection control measures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Nihon Rinsho. Japanese Journal of Clinical Medicine 60(11): 2144-2149, 2002

Selective decontamination of the digestive tract and methicillin-resistant Staphylococcus aureus. Lancet 339(8806): 1411-1412, 1992