Prevention of bacterial colonization of the respiratory tract and stomach of mechanically ventilated patients by a novel regimen of selective decontamination in combination with initial systemic cefotaxime

Abstract

A novel regimen of selective decontamination (SDD) with initial systemic cefotaxime prevented bacterial colonization of the oropharynx and stomach in mechanically ventilated patients. In a three-group study of all patients receiving prolonged mechanical ventilation, patients in control groups A and B received antibiotics only when infection was present. In group A, antibiotics that disturb colonization resistance (CR) were used. In group B, antibiotics use was restricted to antibiotics not affecting CR. Patients in group C received SDD, consisting of norfloxacin, polymyxin E and amphotericin B, administered via a gastric tube and applied to the oropharynx. Group C patients further received an initial five day course of cefotaxime, 500 mg tid. The lower respiratory tract was colonized with microorganisms on admission in about half of the patients, and this persisted in both control groups. In group C, lower respiratory tract colonization was eliminated in all patients after five days. In both control groups about 90% of the patients acquired microbial colonization of the oropharynx and stomach, mostly with Gram-negative bacilli. In group C, only 12% and 24% of the patients acquired colonization of the oropharynx and stomach respectively (P less than 0.001). The oropharynx and stomach were the major sources of microorganisms causing lower respiratory tract infection in both control groups. In group C, elimination of oropharyngeal and gastric colonization completely prevented lower respiratory tract infection from these sources.

The use of topical nonabsorbable gastrointestinal antifungal prophylaxis to prevent fungal infections in critically ill immunocompetent patients: A meta-analysis

“…1) (14,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). One study applied amphotericin B through the nasogastric tube and nystatin to the oropharyngeal cavity (37), four studies applied nystatin at both locations (38 -41), and 10 studies applied topical amphotericin B to both locations (42)(43)(44)(45)(46)(47)(48)(49)(50)(51).…”

Oropharynx microbiota among alcoholics and non-alcoholics

“…Many authors (18)(19)(20)(21)(22)(23) accept knowledge of oropharingeal microbiota as an excellent indicator for possible agents of bacterial infection of the lower airways, therefore allowing physicians to adequately prescribe antimicrobial therapy avoiding indiscriminate use of antibiotics, singly or in association, which as well as being harmful are expensive for the patients and the community.…”

“…Taking into consideration several studies stressing knowledge of the normal oropharingeal flora as an important predictive factor for pulmonary infection cases, (18)(19)(20)(21)(22)(23) the authors proceeded to make a search among heavy alcohol drinkers, since they could harbour a higher number of anaerobic bacteria in the oropharynx, which could be an important etiopathogenic factor in such infections. In the present study, 84.5% of alcoholics were identified as having anaerobic bacteria in the oropharynx, against 30.5% in non-alcoholics.…”