After stratification on initial intragastric pH into two groups, patients from both groups were randomly assigned to receive either antacids (a suspension of aluminum hydroxide and magnesium hydroxide), 30 mL every 4 h, or sucralfate, 1 g every 4 h. Continuous intragastric pH monitoring was performed in 112 patients (58 antacids, 54 sucralfate). Using predetermined criteria, colonization of stomach, oropharynx, and trachea, and the incidence of VAP were assessed. Altogether, 141 patients were included (74 receiving antacids, 67 sucralfate) and continuous intragastric pH monitoring was performed in 112 patients, with a mean of 75 h per patient. The median pH and the percentage of time with a pH < 4.0 were calculated from each measurement. No significant differences in median pH values (4.7 +/- 2.2 and 4.5 +/- 2.0 for antacids and sucralfate, respectively) were observed. Median pH values were higher in patients with gastric bacterial colonization than in noncolonized patients (5.5 +/- 2.1 and 3.3 +/- 2.0, p < 0.01), but colonization of oropharynx and trachea was not related to intragastric acidity. Thirty-one patients (22%) developed VAP, with a similar incidence in both treatment groups. In addition, antibiotic use, duration of hospitalization, and mortality rates were similar in both groups. Enteral feeding did not change intragastric acidity significantly but increased gastric colonization with Enterobacteriaceae, without influencing oropharyngeal and tracheal colonization. Antacids and sucralfate had a similar effect on intragastric acidity, colonization rates, and incidence of VAP. Intragastric acidity influenced gastric colonization but not colonization of the upper respiratory tract or the incidence of VAP. Therefore, it is unlikely that the gastropulmonary route is important for the development of VAP.

No abstract

The influence of topical antimicrobial prophylaxis (TAP) on colonization of oropharynx and trachea was studied in patients receiving and not receiving prophylaxis. Twenty-two patients in Intensive Care Unit (ICU) I (Group 1) received TAP (tobramycin, colistin, and amphotericine B in oropharynx and stomach). Simultaneous to Group 1, 21 patients (Group 2) not receiving TAP were studied in ICU I. A control group of patients admitted to another, identical, ICU (ICU II), where no TAP was administered, were studied simultaneously (Group 3a, n = 23). A second control group (Group 3b, n = 31), was formed by collecting data from patients admitted to ICU I in Period II. Patients receiving TAP were less frequently colonized than patients not receiving prophylaxis. Moreover, of the patients not receiving TAP, those staying in the ICU where TAP was administered (Group 2) were less frequently colonized than patients in another ICU (Group 3). Of the patients not colonized on admission, those staying in the ICU where TAP was administered remained free of colonization for a longer time. In the ICU where no TAP was administered, more patients were colonized simultaneously and cross-acquisition occurred more frequently. TAP significantly influenced colonization of oropharynx and trachea in patients receiving and not receiving prophylaxis within the same ICU as compared with patients not receiving prophylaxis in another identical ICU.

Generally, reduction of colonization and infection with potentially pathogenic microorganisms in intensive care units (ICU) is attempted by a combination of antimicrobial agents administered topically in the digestive tract and systematically. We tested the efficacy of topical antimicrobial prophylaxis of the oropharynx and stomach administered in combination with sucralfate without systemic prophylaxis in 25 mechanically ventilated ICU patients. The regimen successfully reduced colonization with potentially pathogenic microorganisms in the oropharynx and trachea without modifying the intestinal flora. However, colonization and infections with gram-positive cocci and gram-negative rods other than Enterobacteriaceae and Pseudomonadaceae and resistant to one or both the antimicrobial agents used were observed.

SUMMARYA prospective cohort study using electronic medical records was undertaken to estimate the relative risk (RR) of irritable bowel syndrome (IBS) following acute gastroenteritis (GE) in primary-care patients in The Netherlands and explore risk factors. Patients aged 18-70 years who consulted for GE symptoms from 1998 to 2009, met inclusion/exclusion criteria and had at least 1 year of follow-up data were included. Patients with non-GE consultations, matched by age, gender, consulting practice and time of visit, served as the reference group. At 1 year, 1·2% of GE patients (N = 2428) had been diagnosed with IBS compared to 0·3% of the reference group (N = 2354). GE patients had increased risk of IBS [RR 4·85, 95% confidence interval (CI) 2·02-11·63]. For GE patients, concomitant cramps and history of psycho-social consultations were significantly associated with increased risk. GE patients had increased risk of IBS up to 5 years post-exposure (RR 5·40, 95% CI 2·60-11·24), suggesting there may be other contributing factors.