Selective digestive decontamination and antibiotic resistance: A balancing act *

Bonten, Marc J. M.; Grundmann, Hajo

doi:10.1097/01.ccm.0000080491.46005.3f

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…In these studies, systemic antibiotics were not used. Nevertheless, the emergence of multiresistant microorganisms remained a major concern, and cost, because treatment required extensive nursing care (13,14,23,24).…”

Section: Discussionmentioning

confidence: 99%

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma*

Séguin

Tanguy

Laviolle

et al. 2006

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma*

Séguin

Tanguy

Laviolle

et al. 2006

Critical Care Medicine

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“…Pathogen colonization of the nasopharynx and oropharynx predisposes patients to the development of nosocomial pneumonia, and bacterial overgrowth in the digestive tract may result in bacterial translocation and sepsis. Selective decontamination of the digestive tract (SDD), which aims to eradicate colonization of pathogens from digestive tract, is one of the strategies used to reduce ventilator associated pneumonia and sepsis in critically ill patients (Bonten and Grundmann 2003;de Jonge et al 2003;Pittet et al 2001).…”

Section: Prevention Against E Coli Infection and Nosocomial Infectionmentioning

confidence: 99%

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

et al. 2011

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Escherichia coli (E. coli) are the most common aerobic gram-negative bacilli in a normal intestinal tract. They cause most of the intra-abdominal infections, wound infections associated with abdominal surgery, and septicemia. Most of these infections are of endogenous intestinal origin. Lactoferrin (LF) is an iron-binding glycoprotein found in milk and various external secretions. This protein has been found to have a number of biological functions, including antimicrobial, anti-cancer, antioxidant, and immunomodulatory effects. Partial degradation of LF by pepsin can give rise to peptides termed lactoferricin (LFcin) with more potent antimicrobial activity. LF and LFcin have been shown to inhibit the growth of a number of pathogenic bacteria (including E. coli and antibiotic-resistant strains), fungi, and even viruses in both in vitro and in vivo studies. We previously demonstrated that both recombinant porcine LF (pLF) produced from yeast and a synthetic 20-residue porcine LFcin peptide exhibit antimicrobial activity in vitro. In one of our recent studies, we performed pathogen challenges, including pathogenic E. coli, Staphylococcus aureus and Candida albicans, of the digestive tract of a transgenic milk-fed animal model. The results showed that LF has broad spectrum antimicrobial activity in the digestive tract and protects the mucosa of the small intestine from injury. Our following study also revealed that pLF as a feedstuff additive enhances avian immunity, including antibody formation and cell-mediated immunity. All of these results suggest that LF could be a novel natural protein in the treatment and prevention of infections with E. coli or antibiotic-resistant bacteria strains.

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“…Most but not all have demonstrated a beneficial effect in the reduction of VAP, but few have demonstrated reduction in VAP-related ICU mortality [203,204]. Regardless of efficacy, a real concern relates to the promotion of antimicrobial resistance with the longterm use of selective gut decontamination [205,206]. The above concerns, coupled with little to no effect on ICU mortality, have dampened enthusiasm for the use of selective gut decontamination.…”

Section: Prevention Of Aspirationmentioning

confidence: 99%

Ventilator-Associated Pneumonia: A Review

Davis

2006

J Intensive Care Med

125

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Ventilator-associated pneumonia is the most frequent intensive care unit (ICU)-related infection in patients requiring mechanical ventilation. In contrast to other ICU-related infections, which have a low mortality rate, the mortality rate for ventilator-associated pneumonia ranges from 20% to 50%. These clinically significant infections prolong duration of mechanical ventilation and ICU length of stay, underscoring the financial burden these infections impose on the health care system. The causes of ventilator-associated pneumonia are varied and differ across different patient populations and different types of ICUs. This varied presentation underscores the need for the intensivist treating the patient with ventilator-associated pneumonia to have a clear knowledge of the ambient microbiologic flora in their ICU. Prevention of this disease process is of paramount importance and requires a multifaceted approach. Once a diagnosis of ventilator-associated pneumonia is suspected, early broad-spectrum antibiotic administration decreases morbidity and mortality and should be based on knowledge of the sensitivities of common infecting organisms in the ICU. De-escalation of therapy, once final culture results are available, is necessary to minimize development of resistant pathogens. Duration of therapy should be based on the patient's clinical response, and every effort should be made to minimize duration of therapy, thus further minimizing the risk of resistance.

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Selective digestive decontamination and antibiotic resistance: A balancing act *

Cited by 8 publications

References 18 publications

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma*

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma*

Lactoferrin: an iron-binding antimicrobial protein against Escherichia coli infection

Ventilator-Associated Pneumonia: A Review

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