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Selective digestive decontamination

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https://www.readbyqxmd.com/read/29300363/unusually-high-incidences-of-staphylococcus-aureus-infection-within-studies-of-ventilator-associated-pneumonia-prevention-using-topical-antibiotics-benchmarking-the-evidence-base
#1
James C Hurley
Selective digestive decontamination (SDD, topical antibiotic regimens applied to the respiratory tract) appears effective for preventing ventilator associated pneumonia (VAP) in intensive care unit (ICU) patients. However, potential contextual effects of SDD on Staphylococcus aureus infections in the ICU remain unclear. The S. aureus ventilator associated pneumonia (S. aureus VAP), VAP overall and S. aureus bacteremia incidences within component (control and intervention) groups within 27 SDD studies were benchmarked against 115 observational groups...
January 4, 2018: Microorganisms
https://www.readbyqxmd.com/read/29244080/quantification-of-methadone-and-main-metabolites-in-nails
#2
Teresa Patrícia Magalhães, Sara Cravo, Diana Dias da Silva, Ricardo Jorge Dinis-Oliveira, Carlos Afonso, Maria de Lourdes Bastos, Helena Carmo
The quantification of drugs of abuse in keratinized matrices is becoming of special relevance for monitoring consumption and for post-mortem investigations. We aimed to implement an analytical method for the simultaneous detection of morphine (MORF), 6-monoacetylmorphine (6-MAM), methadone (MET), 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and 2-ethyl-5-methyl-3,3-diphenylpyrrolidine (EMDP) in nails. After decontamination, the nail samples (30 mg) were submitted to an alkaline digestion followed by a two-step liquid-liquid and SPE extraction using mixed-mode cation exchange cartridges...
December 13, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/29186403/associations-between-enteral-colonization-with-gram-negative-bacteria-and-intensive-care-unit-acquired-infections-and-colonization-of-the-respiratory-tract
#3
Jos F Frencken, Bastiaan H J Wittekamp, Nienke L Plantinga, Cristian Spitoni, Kirsten van de Groep, Olaf L Cremer, Marc J M Bonten
Background: Enteral and respiratory tract colonization with gram-negative bacteria may lead to subsequent infections in critically ill patients. We aimed to clarify the interdependence between gut and respiratory tract colonization and their associations with intensive care unit (ICU)-acquired infections in patients receiving selective digestive tract decontamination (SDD). Methods: Colonization status of the rectum and respiratory tract was determined using twice-weekly microbiological surveillance in mechanically ventilated subjects receiving SDD between May 2011 and June 2015 in a tertiary medical-surgical ICU in the Netherlands...
September 16, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29119289/local-antibiotic-decontamination-to-prevent-anastomotic-leakage-short-term-outcome-in-rectal-cancer-surgery
#4
Ulrich Wirth, Susanne Rogers, Kristina Haubensak, Stefan Schopf, Thomas von Ahnen, Hans Martin Schardey
PURPOSE: Anastomotic leakage still presents an issue in rectal cancer surgery with rates of about 11%. As bacteria play a critical role, there is the concept of perioperative local decontamination to prevent anastomotic leakage. METHODS: To ascertain the effectiveness of this treatment, we performed a retrospective analysis on 206 rectal resections with primary anastomosis and routine use of a selective decontamination of the digestive tract (SDD) regimen for local decontamination...
November 8, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/29103639/surveillance-guided-selective-digestive-decontamination-of-carbapenem-resistant-enterobacteriaceae-in-the-intensive-care-unit-a-cost-effectiveness-analysis
#5
Joyce H S You, Hong-Kiu Li, Margaret Ip
BACKGROUND: Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). METHODS: Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss...
November 2, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28894438/characterization-of-enterococcus-isolates-colonizing-the-intestinal-tract-of-intensive-care-unit-patients-receiving-selective-digestive-decontamination
#6
Teresita D J Bello Gonzalez, Phu Pham, Janetta Top, Rob J L Willems, Willem van Schaik, Mark W J van Passel, Hauke Smidt
Enterococci have emerged as important opportunistic pathogens in intensive care units (ICUs). In this study, enterococcal population size and Enterococcus isolates colonizing the intestinal tract of ICU patients receiving Selective Digestive Decontamination (SDD) were investigated. All nine patients included in the study showed substantial shifts in the enterococcal 16S rRNA gene copy number in the gut microbiota during the hospitalization period. Furthermore, 41 Enterococcus spp. strains were isolated and characterized from these patients at different time points during and after ICU hospitalization, including E...
2017: Frontiers in Microbiology
https://www.readbyqxmd.com/read/28870727/selective-digestive-and-oropharyngeal-decontamination-in-medical-and-surgical-icu-patients-individual-patient-data-meta-analysis
#7
N L Plantinga, A M G A de Smet, E A N Oostdijk, E de Jonge, C Camus, W A Krueger, D Bergmans, J B Reitsma, M J M Bonten
OBJECTIVES: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) improved intensive care unit (ICU), hospital and 28-day survival in ICUs with low levels of antibiotic resistance. Yet it is unclear whether the effect differs between medical and surgical ICU patients. METHODS: In an individual patient data meta-analysis, we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects...
September 1, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28803549/comparative-gut-microbiota-and-resistome-profiling-of-intensive-care-patients-receiving-selective-digestive-tract-decontamination-and-healthy-subjects
#8
Elena Buelow, Teresita D J Bello González, Susana Fuentes, Wouter A A de Steenhuijsen Piters, Leo Lahti, Jumamurat R Bayjanov, Eline A M Majoor, Johanna C Braat, Maaike S M van Mourik, Evelien A N Oostdijk, Rob J L Willems, Marc J M Bonten, Mark W J van Passel, Hauke Smidt, Willem van Schaik
BACKGROUND: The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective decontamination of the digestive tract" (SDD), is used in some countries where it improves clinical outcome in ICU patients. Yet, the impact of ICU hospitalization and SDD on the gut microbiota remains largely unknown...
August 14, 2017: Microbiome
https://www.readbyqxmd.com/read/28797573/digestive-decontamination-in-burn-patients-a-systematic-review-of-randomized-clinical-trials-and-observational-studies
#9
REVIEW
Mercedes Rubio-Regidor, Ana Martín-Pellicer, Luciano Silvestri, Hendrik K F van Saene, José A Lorente, Miguel A de la Cal
OBJECTIVE: The objective of this systematic review is to assess the effect of selective digestive decontamination (SDD) or non-absorbable enteral antibiotics (EA) on mortality, the incidence of infection and its adverse effects in burn patients. MATERIAL AND METHODS: Systematic review of randomized clinical trials (RCT) or observational studies enrolling burn patients, and comparing SDD or EA prophylaxis with placebo or no treatment. The search includes Pubmed/Medline, EMBASE, WOS, Cochrane Library (1970-2015)...
August 7, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28759469/what-is-new-in-the-prevention-of-nosocomial-pneumonia-in-the-icu
#10
Michael Klompas
PURPOSE OF REVIEW: To summarize and contextualize recent evidence on preventing ventilator-associated pneumonia (VAP). RECENT FINDINGS: Many centers continue to report dramatic decreases in VAP rates after implementing ventilator bundles. Interpreting these reports is complicated, however, by the subjectivity and lack of specificity of VAP definitions. More objective data suggest VAP rates may not have meaningfully changed over the past decade. If so, this compels us to re-examine and revise the prevention bundles we have been using to prevent VAP...
October 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28616203/reduced-rate-of-intensive-care-unit-acquired-gram-negative-bacilli-after-removal-of-sinks-and-introduction-of-water-free-patient-care
#11
Joost Hopman, Alma Tostmann, Heiman Wertheim, Maria Bos, Eva Kolwijck, Reinier Akkermans, Patrick Sturm, Andreas Voss, Peter Pickkers, Hans Vd Hoeven
BACKGROUND: Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of 'water-free' patient care on gram-negative bacilli colonization rates. METHODS: We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28607344/surviving-sepsis-campaign-guidelines-2016-omission-of-selective-decontamination-of-the-digestive-tract-deprives-patients-of-a-level-2b-therapy
#12
Luciano Silvestri, Hendrick K van Saene, Johannes H Rommes, Andy J Petros, Miguel A de la Cal, Julian F Bion
No abstract text is available yet for this article.
June 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28348791/successful-treatment-of-recurrent-helicobacter-fennelliae-bacteraemia-by-selective-digestive-decontamination-with-kanamycin-in-a-lung-cancer-patient-receiving-chemotherapy
#13
Yoshihiro Fujiya, Maki Nagamatsu, Junko Tomida, Yoshiaki Kawamura, Kei Yamamoto, Momoko Mawatari, Satoshi Kutsuna, Nozomi Takeshita, Kayoko Hayakawa, Shuzo Kanagawa, Kazuhisa Mezaki, Masao Hashimoto, Satoru Ishii, Norio Ohmagari
INTRODUCTION: Helicobacter fennelliae is an enterohepatic Helicobacter species causing bacteraemia in immunocompromised hosts. Only a few cases of recurrent H. fennelliae bacteraemia have been reported in Japan and there are no guidelines regarding antimicrobial treatment for H. fennelliae infection. CASE PRESENTATION: H. fennelliae bacteraemia was observed in a patient receiving platinum-based chemotherapy for lung cancer. To prevent recurrence, the patient received antibiotic therapy with cefepime, amoxicillin and doxycycline for 6 weeks, which is similar to the therapy for Helicobactercinaedi bacteraemia...
October 2016: JMM Case Reports
https://www.readbyqxmd.com/read/28267670/selective-digestive-decontamination-in-critically-ill-children-a-survey-of-canadian-providers
#14
Srinivas Murthy, Nazima Pathan, Brian H Cuthbertson
BACKGROUND: Selective digestive decontamination of the digestive tract involves the routine administration of oral, gastric, and intravenous antibiotics to mechanically ventilated children to prevent hospital-acquired infections. It has a strong evidence base in adults, with limited pediatric evidence. Current utilization of this intervention among pediatric physicians in North America is unknown. METHODS: An electronic survey administered to pediatric critical care and pediatric infectious disease providers in Canada...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27858411/increasing-intensity-of-selective-digestive-decontamination-sdd-dosing-does-not-result-in-improved-clinical-outcomes
#15
Johanna M Pieterse, Dinis Dos Reis Miranda, Wim Rietdijk, Jan Bakker
No abstract text is available yet for this article.
November 18, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27755474/selective-digestive-decontamination-attenuates-organ-dysfunction-in-critically-ill-burn-patients
#16
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
https://www.readbyqxmd.com/read/27600049/genomic-characterization-of-colistin-heteroresistance-in-klebsiella-pneumoniae-during-a-nosocomial-outbreak
#17
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 multidrug resistance, which has led to a renewed interest in polymyxin antibiotics, such as colistin, as antibiotics of last resort. However, heteroresistance (i.e., the presence of a subpopulation of resistant bacteria in an otherwise susceptible culture) may hamper the effectiveness of colistin treatment in patients. In a previous study, we showed that colistin resistance among extended-spectrum-beta-lactamase (ESBL)-producing K...
November 2016: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/27584588/reducing-the-impact-of-carbapenem-resistant-enterobacteriaceae-on-vulnerable-patient-groups-what-can-be-done
#18
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...
December 2016: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/27533048/an-outbreak-of-clostridium-difficile-ribotype-027-associated-with-length-of-stay-in-the-intensive-care-unit-and-use-of-selective-decontamination-of-the-digestive-tract-a-case-control-study
#19
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
https://www.readbyqxmd.com/read/27488086/is-selective-digestive-decontamination-useful-for-critically-ill-patients
#20
Alexandre Biasi Cavalcanti, Thiago Lisboa, Ana Cristina Gales
In this study 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 nonabsorbable 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...
January 2017: Shock
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