Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs

Oostdijk, Evelien; Kesecioğlu, Jozef; Schultz, Marcus J.; Visser, Caroline E.; Jonge, Evert de; Essen, E. H. R. van; Bernards, A.T.; Purmer, Ilse M.; Brimicombe, R.W.; Bergmans, Dennis C. J. J.; Tiel, Frank van; Bosch, Frank H.; Mascini, Ellen M.; Griethuysen, Arjanne van; Bindels, Alexander J. G. H.; Jansz, A; Steveninck, Fred A L van; Zwet, W.C. van der; Fijen, J. W.; Thijsen, Steven; Jong, Remko de; Oudbier, Joke; Raben, Adrienne; Vorm, Eric van der; Koeman, Mirelle; Rothbarth, P. H.; Rijkeboer, A. A.; Gruteke, P; Hart-Sweet, Helga B.; Peerbooms, P. G. H.; Winsser, Lex J; Elsacker-Niele, Anne-Marie W van; Demmendaal, Kees; Brandenburg, A. H.; Smet, Anne Marie G. A. de; Bonten, Marc J. M.

doi:10.1001/jama.2014.7247

Cited by 157 publications

(127 citation statements)

References 21 publications

(31 reference statements)

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…Two general approaches have been investigated to “manipulate” the ICU microbiome: probiotic administration and selective decontamination of the skin, gut, or oropharynx. Each of these strategies carries documented risks (e.g., antibiotic resistance) and benefits (e.g., reduced incidence of nosocomial infections) [34–36]. Importantly, these strategies have been implemented without personalized knowledge of the microbiota in the patients receiving these interventions.…”

Section: Discussionmentioning

confidence: 99%

Disruption of the microbiota across multiple body sites in critically ill children

et al. 2016

View full text Add to dashboard Cite

BackgroundDespite intense interest in the links between the microbiome and human health, little has been written about dysbiosis among ICU patients. We characterized microbial diversity in samples from 37 children in a pediatric ICU (PICU). Standard measures of alpha and beta diversity were calculated, and results were compared with data from adult and pediatric reference datasets.ResultsBacterial 16S rRNA gene sequences were analyzed from 71 total tongue swabs, 50 skin swabs, and 77 stool samples or rectal swabs. The mean age of the PICU patients was 2.9 years (range 1–9 years), and many were chronically ill children that had previously been hospitalized in the PICU. Relative to healthy adults and children, alpha diversity was decreased in PICU GI and tongue but not skin samples. Measures of beta diversity indicated differences in community membership at each body site between PICU, adult, and pediatric groups. Taxonomic alterations in the PICU included enrichment of gut pathogens such as Enterococcus and Staphylococcus at multiple body sites and depletion of commensals such as Faecalibacterium and Ruminococcus from GI samples. Alpha and beta diversity were unstable over time in patients followed longitudinally. We observed the frequent presence of “dominant” pathogens in PICU samples at relative abundance >50%. PICU samples were characterized by loss of site specificity, with individual taxa commonly present simultaneously at three sample sites on a single individual. Some pathogens identified by culture of tracheal aspirates were commonly observed in skin samples from the same patient.ConclusionsWe conclude that the microbiota in critically ill children differs sharply from the microbiota of healthy children and adults. Acknowledgement of dysbiosis associated with critical illness could provide opportunities to modulate the microbiota with precision and thereby improve patient outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40168-016-0211-0) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Disruption of the microbiota across multiple body sites in critically ill children

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Colonized patients pose an epidemiological threat to other hospitalized individuals and to members of their households [6,7] but are also in danger of developing systemic infections with gut-colonizing microorganisms [8,9]. This is especially the case for patients with blood disorders due to suppression of their innate and/or acquired immunity.…”

mentioning

confidence: 99%

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Biliński

Grzesiowski²,

Sørensen

et al. 2017

Clinical Infectious Diseases

230

176

View full text Add to dashboard Cite

Background.Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria in a murine model of enterococcal colonization of the gut can lead to eradication of enterococci. We hypothesized that fecal microbiota transplantation (FMT) could be used to eradicate ARB in humans.Methods. Participants colonized with ARB were treated with intraduodenal FMT according to a prospective protocol (NCT02461199). The primary endpoint was complete ARB decolonization at 1 month after FMT. Secondary endpoints included safety assessment and partial ARB decolonization. Microbiome sequencing was performed to investigate the influence of microbial composition of the transplanted material on the outcome of FMT.Results. Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2 (range, 1-4) strains of ARB. The primary endpoint was reached in 15/25 (60%) of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics (79% vs 36%, P < .05). Among participants, 15/20 (75%) experienced complete ARB decolonization. There were no severe adverse events, and partial ARB decolonization was observed in 20/25 (80%) of the FMTs. The microbiota composition analysis revealed higher abundance of Barnesiella spp., Bacteroides, and Butyricimonas and greater bacterial richness in the fecal material, resulting in eradication of Klebsiella pneumoniae compared with nonresponders.Conclusions. FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract. Clinical Trials Registration. NCT02461199.

show abstract

“…Of the included patients, 73 participated in one of two controlled, cluster-randomised crossover studies in which SOD, SDD and no antibiotics [11] or SOD and SDD [12] were compared. In these studies, the treatment regime would only be assigned if the anticipated stay in the ICU was more than 72 h and/or expected duration of intubation was more than 48 h. Therefore, in order to equalize our inclusion criteria, all included patients outside these study periods had to have an ICU length-of-stay of at least 72 h, irrespective of intubation status.…”

Section: Methodsmentioning

confidence: 99%

Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

Effects of Decontamination of the Oropharynx and Intestinal Tract on Antibiotic Resistance in ICUs

Abstract: trialregister.nlIdentifier: NTR1780.

Cited by 157 publications

References 21 publications

Disruption of the microbiota across multiple body sites in critically ill children

Disruption of the microbiota across multiple body sites in critically ill children

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit

Contact Info

Product

Resources

About