ISSN:
1432-1238
Keywords:
Selective tract digestive decontamination
;
Erythromycin-base
;
Beta lactamase
;
Nosocomial infection
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective To study the effect of selective digestive tract decontamination by erythromycin-base on the incidence of carriage and infection with MREnterobacteriaceae producing an extended spectrum beta-lactamase (ESB). Design After a 10-week prospective survey to ascertain the baseline incidence in two bays (1 and 3) of the same ICU, bay 1 was compared with bay 3 during a further survey of 6 moths. The patients in bya 1. received erythromycin-base. Setting Two non-contiguous bays, 1 and 3, of 4 beds, in the same polyvalent ICU of a university hospital. Patient Consecutive patients with unit stay longer than 2 days; 34 patients were included during the control period, 43 in bay 1 (decontamination) and 46 in bay 3 (control) during the trial period. Intervention Erythromycin-base, 1 g t.i.d. in powder form administered by gastric tube to patients in bay 1 from admission to discharge. Measurements and results Digestive tract carriage was monitored by cultures of gastric and rectal swab specimens, sampled twice a week.Enterobacteriaceae were isolated on Drigalski agar with incorporated ceftazidime (4 mg/l). In bay 1 there was a decrease in ESB producingEnterobacteriaceae (23% vs 10%,p=0.0004) from rectal swab, especially inK. pneumoniae (15% vs 2%,p=10−5), during the decontamination period in comparison to the control period. During the trial period the only differences observed between bays 1 and 3 were in the gastric samples:K. pneumoniae were less often isolated in bay 1 than in bay 3 (0% vs 3%,p=0.03). Intestinal carriage with multiresistantEnterobacteriaceae occurred in 28% patients in bay 1 and 30% patients in bay 3 during the trial period (p=0.79). Erythromycin-base did not delay the carriage by patients in bay 1 (log rank testp=0.42). Conclusion Erythromycin-base was not effective in preventing digestive tract carriage due toEnterobacteriaceae resistant to third generation cephalosporin by production of chromosomal cephalosporinase. The decrease in isolates containingK. pneumoniae in bay 1 cannot be definitively attributed to erythromycin-base, since the number of this species in bay 3 was low.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01694769
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