Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract

Sleijfer, Dirk; Mulder, Nanno; Vries-Hospers, H. G. de; Fidler, V.; Nieweg, H. O.; Waaij, D. van der; Saene, H. K. F. van

doi:10.1016/0014-2964(80)90140-1

Cited by 207 publications

(49 citation statements)

References 36 publications

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“…SD is the selective complete suppression of aerobic Gram-negative bacilli in the digestive tract, while maintaining the protective indigenous anaerobic microflora intact (Sleijfer et al 1980;Winston et al 1987).…”

Section: Introductionmentioning

confidence: 99%

A norfloxacin dose finding study for selective decontamination of the digestive tract in pigs

Waaij

Messerschmidt²,

Waaij³

1989

Epidemiol. Infect.

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SUMMARYFive pigs were treated orally with norfloxacin for 5 consecutive days in two wellseparated periods. This was done to determine the lowest dose required to free the pigs of Enterobacteriaceae. In the first period of the study, the animals were treated with 400 mg per day while in the second treatment 800 mg norfloxacin was given. Daily faecal culturing indicated that the faeces became free of Enterobacteriaceae in 3-5 days when treated with 400 mg/day, while all animals were found negative on culturing after 3 days of treatment with 800 mg/day. Investigation of the concentration of norfloxacin in the faeces revealed that a substantial fraction of the dose was either absorbed or inactivated by faecal substances. An in vitro study in faeces confirmed that a substantial part, some 75 % of the dose, may have been inactivated by intestinal contents. This finding helps to explain the much lower concentration of 120 mg norfloxacin per kg of faeces in the pig in comparison with the almost tenfold higher concentration reported to develop in man during treatment with an identical dose.

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Section: Introductionmentioning

confidence: 99%

A norfloxacin dose finding study for selective decontamination of the digestive tract in pigs

Waaij

Messerschmidt²,

Waaij³

1989

Epidemiol. Infect.

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“…Faecal enterococci have been used as an indicator of an intact anaerobic flora and hence of CR in mice (van der Waaij & Berghuis, 1974) and in humans (Sleijfer et al 1980;de Vries-Hospers et al 1981) as enterococci are resistant to the antibiotics used in SDD and are simpler to estimate than the intestinal anaerobic flora. If, as this study suggests, the addition of Ctx suppresses lactobacilli and thus allows overgrowth by the enterococcal population, monitoring of the latter as indicators of anaerobic flora and hence of CR may be inappropriate.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is difficult to extrapolate directly from mice, similar outgrowth of enterococci after parenteral Ctx may occur in humans (Lambert-Zechovsky et al 1985). Many patients to whom SDD is of potential benefit are severely immunocompromised (Guiot et al 1983;Hargadon et al 1981;Heimdahl et al 1984;Sleijfer et al 1980) and under these conditions a rise in any intestinal bacterial group with possibly enhanced translocation to spleen and lymph nodes may be hazardous.…”

Section: Discussionmentioning

confidence: 99%

“…This maintenance of the anaerobic flora prevents overgrowth by drugresistant aerobes, a phenomenon termed colonization resistance (CR) (van der Waaij, Berghuis-de Vries & Lekkerkerk-van der Wees, 1972). In humans, such techniques have been used with some success to reduce infection of endogenous origin in granulocytopoenic patients (Guiot et al 1983;Hargadon et al 1981;Sleijfer et al 1980). Recently, SDD has been applied to patients in an intensive therapy unit (ITU) and has achieved a striking reduction in infection rates (Stoutenbeek et al 1984).…”

Section: Introductionmentioning

confidence: 99%

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The effect of selective decontamination of the digestive tract with the addition of systemic cefotaxime on the aerobic faecal flora of mice

et al. 1987

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SUMMARYThe administration per-orally to mice of the non-absorbable antibiotics polymyxin E, tobramycin and amphotericin B resulted in the elimination of detectable aerobic gram-negative rods from the faecal flora without affecting the total viable aerobic count. The addition of parental cefotaxime to the regime caused a fall in the number of aerobic lactobacilli and an increase in the number of enterococci. The rise was associated with the translocation of viable enterococci to the mesenteric lymph nodes and the spleen. The changes induced by cefotaxime were reversed when the antibiotic was withdrawn. Following withdrawal of all antibiotics the total aerobic faecal flora increased to above normal levels, but there was no associated diarrhoea. Attempts to implant exogenous enterobacteria into the digestive tract resulted in only low level colonization both in treated mice and in control mice. These results may have implications for the use of this antibiotic regime for selective decontamination of the digestive tract in humans, particularly those who are immunocompromised.

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“…In this respect non-absorbable antibiotics are of special interest because they will reach the large bowel. In animal studies (Emmelot & van der van der Waaij et al 1982;Hazenberg et al 1983a) as well as in clinical trials (Sleijfer et al 1980; Vries-Hospers et al 1981; Guiot, van der Meer & van Furth, 1981;Guiot et al 1983;Kurrle et al 1983) low doses ofneomycin and particularly polymyxin B proved to be very useful. In vitro studies on the human intestinal flora showed that the selective effect was associated with a relative insusceptibility of the obligately anaerobic flora as compared with the Gram-negative facultatively anaerobic rods (Hazenberg et al 1983b(Hazenberg et al , 1984.…”

Section: Introductionmentioning

confidence: 99%

Binding to and antibacterial effect of aztreonam, temocillin, gentamicin and tobramycin on human faeces

Hazenberg

Pennock-Schröder

Merwe³

1985

J. Hyg.

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SUMMARYAztreonam, temocillin, gentamicin and tobramycin were studied for their effect on the human faecal flora in vitro and for their usefulness for selective decontamination (SD) of the gastrointestinal tract. The sensitivities of the obligately anaerobic flora and the Gram-negative facultatively anaerobic bacteria were determined and the ratio was expressed as SD factor. The high SD factor of the flora from most subjects for aztreonam and tobramycin indicates that the drugs are useful for SD in contrast to temocillin and gentamicin. Binding to and subsequent release of tobramycin from faeces are presumed to facilitate the maintenance of adequate concentrations in the intestine despite the discontinuous intake.

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Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract

Cited by 207 publications

References 36 publications

A norfloxacin dose finding study for selective decontamination of the digestive tract in pigs

A norfloxacin dose finding study for selective decontamination of the digestive tract in pigs

The effect of selective decontamination of the digestive tract with the addition of systemic cefotaxime on the aerobic faecal flora of mice

Binding to and antibacterial effect of aztreonam, temocillin, gentamicin and tobramycin on human faeces

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