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Selective decontamination of the gastrointestinal tract as an infection control measure
1Department of Microbiology, Withington Hospital, Manchester.
Abstract:
An outbreak caused by a Klebsiella aerogenes resistant to ceftazidime, cefuroxime, cefotaxime, ampicillin and piperacillin and sensitive to aminoglycosides, imipenem and temocillin occurred in a teaching hospital's busy multi-disciplinary Intensive Care Unit over a 3-month period. Four patients had bacteraemia and a further four were colonized. Traditional infection control measures failed to eradicate the outbreak. The introduction of a selective gastrointestinal decontamination regimen consisting of tobramycin, amphotericin and colistin as a gel to the oropharynx, nose and rectum and a suspension via a nasogastric tube resulted in rapid disappearance of the outbreak strain with no new isolates being detected clinically or in surveillance specimens over an 8-week period.
Insights
A multi-drug resistant Klebsiella aerogenes outbreak in an ICU was controlled using selective gastrointestinal decontamination. This regimen rapidly eliminated the resistant bacteria, preventing further infections and colonization.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- An outbreak of multidrug-resistant Klebsiella aerogenes occurred in a hospital's Intensive Care Unit.
- The bacteria exhibited resistance to multiple common antibiotics, including ceftazidime, cefuroxime, cefotaxime, ampicillin, and piperacillin.
- Standard infection control measures were ineffective in controlling the spread.
Purpose of the Study:
- To evaluate the efficacy of selective gastrointestinal decontamination in eradicating a multidrug-resistant Klebsiella aerogenes outbreak.
- To assess the impact of this intervention on new clinical and surveillance isolates.
Main Methods:
- A selective gastrointestinal decontamination regimen was implemented, involving tobramycin, amphotericin, and colistin.
- The decontamination agents were administered topically to the oropharynx, nose, and rectum, and via nasogastric tube.
- Surveillance cultures were performed to monitor for the presence of the outbreak strain.
Main Results:
- The selective gastrointestinal decontamination regimen led to the rapid disappearance of the Klebsiella aerogenes outbreak strain.
- No new clinical or surveillance isolates of the resistant strain were detected during the 8-week follow-up period.
- The intervention successfully controlled the outbreak where traditional methods failed.
Conclusions:
- Selective gastrointestinal decontamination is an effective strategy for controlling outbreaks of multidrug-resistant Gram-negative bacteria in intensive care settings.
- This approach offers a viable alternative when conventional infection control measures are insufficient.
- Further research may explore the long-term impact and broader applicability of this decontamination strategy.