scholarly journals Effect of a Selective Decontamination of the Digestive Tract Regimen Including Parenteral Cefepime on Establishment of Intestinal Colonization with Vancomycin-Resistant Enterococcus spp. and Klebsiella pneumoniae in Mice

2006 ◽  
Vol 50 (7) ◽  
pp. 2537-2540 ◽  
Author(s):  
David L. Paterson ◽  
Usha Stiefel ◽  
Curtis J. Donskey
Keyword(s):  
Klebsiella Pneumoniae ◽  
Digestive Tract ◽  
Selective Decontamination ◽  
Vancomycin Resistant Enterococcus ◽  
Intestinal Colonization ◽  
Concurrent Administration ◽  
Gram Negative ◽  
Enterococcus Spp ◽  
Polymyxin E ◽  
Vancomycin Resistant

ABSTRACT In mice, a selective decontamination of the digestive tract regimen consisting of orogastric tobramycin, polymyxin E, and amphotericin B in combination with subcutaneous cefepime inhibited gram-negative bacilli, including Klebsiella pneumoniae, and did not promote vancomycin-resistant Enterococcus spp. (VRE) colonization. However, concurrent administration of subcutaneous ampicillin-sulbactam resulted in promotion of VRE.

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

1987 ◽  
Vol 98 (3) ◽  
pp. 385-395 ◽  
Author(s):  
A. B. J. Speekenbrink ◽  
S. R. Alcock ◽  
J. Forrester ◽  
D. M. V. Parrott
Keyword(s):  
Lymph Nodes ◽  
Digestive Tract ◽  
Amphotericin B ◽  
Selective Decontamination ◽  
Mesenteric Lymph Nodes ◽  
Faecal Flora ◽  
Gram Negative ◽  
Mesenteric Lymph ◽  
Antibiotic Regime ◽  
Polymyxin E

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 The changes induced by cefotaxime were reversed when the antibiotic was withdrawn.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.

scholarly journals Suppression of Gastric Acid Production by Proton Pump Inhibitor Treatment Facilitates Colonization of the Large Intestine by Vancomycin-Resistant Enterococcus spp. and Klebsiella pneumoniae in Clindamycin-Treated Mice

2006 ◽  
Vol 50 (11) ◽  
pp. 3905-3907 ◽  
Author(s):  
Usha Stiefel ◽  
Agam Rao ◽  
Michael J. Pultz ◽  
Robin L. P. Jump ◽  
David C. Aron ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Klebsiella Pneumoniae ◽  
Large Intestine ◽  
Proton Pump ◽  
Proton Pump Inhibitor Therapy ◽  
Vancomycin Resistant Enterococcus ◽  
Proton Pump Inhibitor Treatment ◽  
Enterococcus Spp ◽  
Vancomycin Resistant ◽  
Inhibitor Treatment

ABSTRACT Proton pump inhibitor treatment of clindamycin-treated mice elevated the gastric pH and facilitated the establishment of colonization of the large intestine by vancomycin-resistant Enterococcus spp. (75 to 80%, versus 20 to 25% for saline-treated controls) and Klebsiella pneumoniae (90%, versus 30% for saline-treated controls). These findings demonstrate a mechanism by which proton pump inhibitor therapy could contribute to the dissemination of nosocomial pathogens.

scholarly journals Efficacy and safety of selective decontamination of the digestive tract (SDD) to prevent recurrent hepatic cyst infections in polycystic liver disease: a retrospective case series

2020 ◽  
Vol 75 (9) ◽  
pp. 2666-2669
Author(s):  
Lucas H P Bernts ◽  
Shosha E I Dekker ◽  
Darius Soonawala ◽  
Roger J M Brüggemann ◽  
Heiman F L Wertheim ◽  
...  
Keyword(s):  
Liver Disease ◽  
Adverse Events ◽  
Digestive Tract ◽  
Case Series ◽  
Hepatic Cyst ◽  
Selective Decontamination ◽  
Polycystic Liver Disease ◽  
Polycystic Liver ◽  
Cyst Infection ◽  
Polymyxin E

Abstract Background Hepatic cyst infection is a complication of polycystic liver disease (PLD) that causes substantial morbidity. Repetitive infection is frequent and is increasingly difficult to treat. As translocated gut bacteria are considered the cause, we hypothesize that selective decontamination of the digestive tract (SDD) reduces recurrence of hepatic cyst infection. Methods We performed a retrospective, observational study in two referral centres. All patients with PLD treated with SDD for hepatic cyst infection were included. Efficacy was determined by calculating the infection incidence (hepatic cyst infections per month) before and during SDD therapy. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE). Results We identified eight patients who received SDD (88% female, 88% polycystic kidney disease). The median age was 65 years (IQR: 51–74 years). SDD lowered the median incidence from 0.09 episodes per month (IQR: 0.06–0.25 episodes per month) to 0.01 episodes per month (IQR: 0.00–0.05 episodes per month) (P = 0.12). Discontinuation of SDD led to rapid recurrence of cyst infection (71% within 6 weeks). SDD consisted of polymyxins with/without aminoglycosides. The median SDD treatment duration was 20 months (range: 3–89 months). Six patients (75%) developed adverse events [CTCAE Grade 1 (gastrointestinal: n = 3) or Grade 3 (ototoxicity: n = 1; fungal infection: n = 1)], mostly attributable to aminoglycosides; one patient developed polymyxin E resistance. Conclusions SDD prophylaxis provides a novel strategy for limiting recurrent hepatic cyst infection in PLD patients. However, adverse events are frequent and curtail its use. As most were attributable to aminoglycosides, polymyxin E is considered the preferred therapy.

scholarly journals The dose at which neomycin and polymyxin B can be applied for selective decontamination of the digestive tract in mice

1980 ◽  
Vol 84 (3) ◽  
pp. 331-340 ◽  
Author(s):  
C. H. Emmelot ◽  
D. Van der Waaij
Keyword(s):  
Digestive Tract ◽  
Oral Treatment ◽  
Polymyxin B ◽  
Selective Decontamination ◽  
Gram Negative Bacteria ◽  
Colonization Resistance ◽  
Streptococcus Faecalis ◽  
Gram Negative

SUMMARYOral treatment of mice with various doses of neomycin or polymyxin B was performed in order to determine which dose caused substantial suppression of aerobic gram-negative rods. In addition the effect of the various doses on Streptococcus faecalis and on other factors of the colonization resistance (CR) of the digestive tract were studied. It was found that polymyxin B was effective in suppressing sensitive gram-negative bacteria following daily doses of 3·2 mg/ mouse, and that even extremely high daily doses of 9·7 mg/mouse did not affect the CR. Neomycin was effective in suppressing Enterobacteriaceae species following oral daily doses of 5·4 mg/mouse. With this dose, however, the CR was somewhat decreased which was also evidenced by the increased concentration of beta-aspartyiglycine in the faeces and the increased size (weight) of the caecum in these animals. Suppression of Sir. faecalis was seen from doses of 24 mg/mouse on.

scholarly journals Microevolution of acquired colistin resistance in Enterobacteriaceae from ICU patients receiving selective decontamination of the digestive tract

2020 ◽  
Author(s):  
Axel B. Janssen ◽  
Denise van Hout ◽  
Marc J.M. Bonten ◽  
Rob J.L. Willems ◽  
Willem van Schaik
Keyword(s):  
Digestive Tract ◽  
Response Regulator ◽  
Multidrug Resistant ◽  
Selective Decontamination ◽  
Opportunistic Pathogens ◽  
Colistin Resistance ◽  
Gram Negative ◽  
Routine Surveillance ◽  
Resistant Strains ◽  
Prophylactic Use

AbstractColistin is an antibiotic that targets the lipopolysaccharides present in the membranes of Gram-negative bacteria. It is used as last-resort drug to treat infections with multidrug-resistant strains. Colistin is also used in selective decontamination of the digestive tract (SDD), a prophylactic therapy used in patients hospitalised in intensive care units (ICUs) to selectively eradicate opportunistic pathogens in the oropharyngeal and gut microbiota. In this study, we aimed to unravel the mechanisms of acquired colistin resistance in Gram-negative opportunistic pathogens obtained from SDD-treated patients.Routine surveillance of 428 SDD-treated patients resulted in thirteen strains with acquired colistin resistance (Escherichia coli n=9; Klebsiella aerogenes, n=3; Enterobacter asburiae, n=1) from five patients. Genome sequence analysis showed that these isolates represented multiple distinct colistin-resistant clones, but that within the same patients, colistin-resistant strains were clonally related. We identified previously described mechanisms that lead to colistin resistance, i.e. a G53 substitution in the response regulator PmrA/BasR, and the acquisition of the mobile colistin resistance gene mcr-1.1, but we also observed novel variants of basR with an 18-bp deletion, and a G19E substitution in the sensor histidine kinase BasS. We experimentally confirmed these variants to contribute to reduced colistin susceptibility. In a single patient, we observed that colistin resistance in a single E. coli clone evolved through two unique variants in basRS.We show that prophylactic use of colistin during SDD can select for colistin resistance in species that are not intrinsically colistin-resistant. This highlights the importance of continued surveillance for the emergence of colistin resistance in patients treated with SDD.

Sign in / Sign up

Export Citation Format

Share Document