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Selective digestive decontamination

Lucía López-Rodríguez, Miguel A de la Cal, Paloma García-Hierro, Raquel Herrero, Judith Martins, Hendrick K F van Saene, José A Lorente
OBJECTIVE: To evaluate whether selective decontamination of the digestive tract (SDD) attenuates organ dysfunction in critically ill burn patients. BACKGROUND: The effect of SDD on the development and progression of organ dysfunction, as an important determinant of mortality in burned patients, is still unknown. We asked whether organ dysfunction is mitigated by treatment with SDD. METHODS: Patients with burns >20% of total body surface or suspected inhalation injury from a randomized placebo-controlled trial were analyzed to determine the relationship between treatment received (placebo or SDD) and the severity of organ dysfunction as measured by the area under the curve of the Sequential Organ Failure Assessment (SOFA) score (and its individual components) from day 1 to day 7 of admission...
November 2016: Shock
Teysir Halaby, Emre Kucukkose, Axel B Janssen, Malbert R C Rogers, Dennis J Doorduijn, Adri G M van der Zanden, Nashwan Al Naiemi, Christina M J E Vandenbroucke-Grauls, Willem van Schaik
Klebsiella pneumoniae is emerging as an important nosocomial pathogen due to its rapidly increasing multi-drug resistance, which has led to a renewed interest into polymyxin antibiotics, such as colistin, as an antibiotic of last resort. However, heteroresistance (i.e. the presence of a sub-population of resistant bacteria in an otherwise susceptible culture) may hamper the effectiveness of colistin treatment in patients. In a previous study, we have shown that colistin resistance among extended-spectrum beta-lactamase-producing K...
September 6, 2016: Antimicrobial Agents and Chemotherapy
Gökhan Metan, Murat Akova
PURPOSE OF REVIEW: Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide challenge and associated with a high mortality rate in critically ill patients. This review focused on rapid diagnosis, optimization of antimicrobial therapy, and implication of effective infection control precautions to reduce impact of CRE on vulnerable patients. RECENT FINDINGS: Several new diagnostic assays have recently been described for the early diagnosis of CRE. Retrospective studies are supportive for colistin plus meropenem combination for the treatment of CRE infections; however, solid evidence is still lacking...
August 31, 2016: Current Opinion in Infectious Diseases
Yvette H van Beurden, Olaf M Dekkers, Marije K Bomers, Annie M Kaiser, Robin van Houdt, Cornelis W Knetsch, Armand R J Girbes, Chris J J Mulder, Christina M J E Vandenbroucke-Grauls
BACKGROUND: An outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study. METHODS: Cases (n = 79), diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316). Patients diagnosed with CDI due to other ribotypes were included as a second control group...
2016: PloS One
Alexandre Biasi Cavalcanti, Thiago Lisboa, Ana Cristina Gales
In this manuscript we review the rationale for using selective digestive decontamination(SDD) in critically ill patients, and its effects on clinical outcomes and rates of infection with antimicrobial resistant microorganisms. SDD consists of the application of non-absorbable antibiotics to the oropharynx and through a nasogastric or nasoenteral tube, in association with a 4-day course of an intravenous third-generation cephalosporin. The enteral component aims at preventing oral and rectal colonization with potentially pathogenic nosocomial aerobic Gram-negative bacilli and yeasts, while preserving normal protective anaerobic enteral flora...
August 2, 2016: Shock
J W Betts, L M Phee, D W Wareham
Selective decontamination of the digestive tract (SDD) using combinations of oral non-absorbable antibiotics has been proposed as a means of preventing multidrug-resistant (MDR) infections. The minimum inhibitory concentrations (MICs) of rifaximin (RIFAX) were determined against 262 Gram-negative and Gram-positive bacterial isolates by broth microtitre assay. Rifampicin (RIF) was used as a comparator in the analysis. Synergistic interactions between RIFAX and polymyxin B (PMB) were assessed by using the chequerboard method and calculating the fractional inhibitory concentration index (FICI)...
March 2016: Journal of Global Antimicrobial Resistance
Susanne Nicole Weber, Annika Bohner, Dianne H Dapito, Robert F Schwabe, Frank Lammert
BACKGROUND: The development of hepatocellular carcinoma (HCC) is a common consequence of advanced liver fibrosis but the interactions between fibrogenesis and carcinogenesis are still poorly understood. Recently it has been shown that HCC promotion depends on Toll-like receptor (TLR) 4. Pre-cancerogenous events can be modelled in mice by the administration of a single dose of diethylnitrosamine (DEN), with HCC formation depending amongst others on interleukin (IL) 6 production. Mice lacking the hepatocanalicular phosphatidylcholine transporter ABCB4 develop liver fibrosis spontaneously, resemble patients with sclerosing cholangitis due to mutations of the orthologous human gene, and represent a valid model to study tumour formation in pre-injured cholestatic liver...
2016: PloS One
R Fernández Fernández, M Herreros Gonzalo, L Serrano Fernández, L Camacho Peinado, N Cruza Leganés, M Á Taberna Izquierdo, F Alba García, F Árbol Linde
No abstract text is available yet for this article.
December 2016: Intensive Care Medicine Experimental
R Fernández Fernández, L Serrano Fernández, L Camacho Peinado, M Herreros Gonzalo, N Cruza Leganés, M Á Taberna Izquierdo, F Alba García, F Árbol Linde
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
S Rebollo, R Jiménez, A Ortín, E Andreu, B Gil, M A López, M Royo-Villanova, L Capilla, J J Rodríguez, A Martínez-Pellús
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
A M Marrero-Rodríguez, E R Argandoña-Primicia, M E Gallardo-Santos, P Juárez-San Juan, C F Lübbe-Vazquez, J J Díaz Díaz, P Saavedra, S Ruiz-Santana
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
C Sánchez Ramirez, L Caipe Balcázar, S Hípola Escalada, M A Hernández Viera, M Cabrera Santana, N Sangil Monroy, A Bordes Benitez, P Saavedra Santana, S Ruiz Santana
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
C Sánchez Ramirez, R Prada Osorio, C F Lübbe Vazquez, R Argandoña Primicia, J Cabrera Arrocha, F Artiles Campelo, S Ruiz Santana
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
C Sánchez Ramirez, M Cabrera Santana, M A Hernández Viera, S Hípola Escalada, L Caipe Balcázar, N Sangil Monroy, A Bordes Benitez, F Artiles Campelo, P Saavedra Santana, S Ruiz Santana
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
J C Hurley
The purpose here is to establish the incidence of respiratory tract colonization with Candida (RT Candida) among ICU patients receiving mechanical ventilation within studies in the literature. Also of interest is its relationship with candidemia and the relative importance of topical antibiotic (TA) use as within studies of selective digestive decontamination (SDD) versus other candidate risk factors towards it. The incidence of RT Candida was extracted from component (control and intervention) groups decanted from studies of various TA and non-TA ICU infection prevention methods with summary estimates derived using random effects...
July 2016: European Journal of Clinical Microbiology & Infectious Diseases
F Hidalgo, D Mas, M Rubio, P Garcia-Hierro
Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns...
April 2016: Medicina Intensiva
Edward J Septimus, Marin L Schweizer
Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S...
April 2016: Clinical Microbiology Reviews
J W G Ng, S A Cairns, C P O'Boyle
BACKGROUND: Burn produces complex gastrointestinal (GI) responses. Treatment, including large volume fluid resuscitation and opioid analgesia, may exacerbate GI dysfunction. Complications include constipation and opioid-induced bowel dysfunction (OBD), acute colonic pseudo-obstruction (ACPO), bacterial translocation and sepsis, and abdominal compartment syndrome (ACS). Contamination of perineal burns contributes to delayed healing, skin graft failure and sepsis and may impact upon morbidity and mortality...
June 2016: Burns: Journal of the International Society for Burn Injuries
Richard J Price, Brian H Cuthbertson
PURPOSE OF REVIEW: Selective digestive or oropharyngeal decontamination has been being used as a means to prevent infections and death in intensive care patients for the past 30 years. It remains controversial and its use is limited. In this review, we summarize the recently published data on efficacy of selective decontamination and effects on antibiotic resistances. RECENT FINDINGS: The most recent meta-analysis shows a reduced mortality when selective digestive or oropharyngeal decontamination are compared with either standard care or oropharyngeal chlorhexidine...
April 2016: Current Opinion in Critical Care
J A Lorente, R Amaya-Villar
The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results...
January 2016: Medicina Intensiva
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