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Selective bowel decontamination results in gram-positive translocation
R J Jackson1, S D Smith, M I Rowe
1University of Pittsburgh School of Medicine, Division of Pediatric Surgery, Pennsylvania.
The Journal of Surgical Research
|May 1, 1990
Summary
Selective bowel decontamination (SBD) effectively removes gram-negative bacteria but may increase gram-positive infections. This study in rats shows SBD leads to Enterococcus overgrowth and translocation, highlighting a potential limitation for critically ill patients.
Area of Science:
- Microbiology
- Critical Care Medicine
- Gastroenterology
Background:
- Enteric gram-negative bacteria translocation is a key infection pathway in critically ill patients.
- Selective bowel decontamination (SBD) aims to prevent infections by targeting pathogenic bacteria.
- Observed gram-positive infections during SBD prompted an investigation into its effects on gut flora.
Purpose of the Study:
- To evaluate the impact of SBD on gut colonization and bacterial translocation.
- To assess the efficacy of SBD in controlling gram-negative bacteria.
- To determine if SBD influences the overgrowth of gram-positive organisms.
Main Methods:
- A rat model was used to compare SBD (enteral polymyxin E, tobramycin, amphotericin B + parenteral cefotaxime) with controls.
- Groups received different antibiotic regimens for 7 days.
- Cultures were performed on cecal contents, mesenteric lymph nodes, liver, and spleen.
Main Results:
- SBD significantly reduced gram-negative bacteria in cecal cultures (8% vs. 100% in controls).
- Enterococcal colony counts were significantly higher in the SBD group (P < 0.01).
- Translocation of Enterococcus to mesenteric lymph nodes increased significantly with SBD (67% vs. 0% in controls, P < 0.01).
Conclusions:
- SBD is effective in eliminating gut gram-negative organisms in a rat model.
- SBD can lead to Enterococcus overgrowth and translocation.
- Gram-positive infections may represent a significant limitation of SBD in clinical practice.