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Selective digestive decontamination by erythromycin-base in a polyvalent intensive care unit
C L de Champs1, D P Guelon, R M Garnier
1Service d'Hygiène Hospitalière, Faculté de Médecine, Clermont-Ferrand, France.
Intensive Care Medicine
|January 1, 1993
Summary
Selective digestive tract decontamination with erythromycin-base did not effectively prevent carriage of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae. While a decrease in ESBL-producing Klebsiella pneumoniae was observed, it could not be definitively attributed to the intervention.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Pharmacy
Background:
- Multiresistant Enterobacteriaceae, particularly those producing extended-spectrum beta-lactamases (ESBLs), pose a significant threat in intensive care units (ICUs).
- Selective digestive tract decontamination (SDD) is a strategy to reduce the incidence of infections caused by such resistant organisms.
Purpose of the Study:
- To evaluate the efficacy of erythromycin-base for selective digestive tract decontamination in reducing carriage and infection rates of ESBL-producing Enterobacteriaceae in an ICU setting.
Main Methods:
- A prospective study was conducted in two ICU bays, with one bay receiving erythromycin-base (1 g t.i.d. via gastric tube) and the other serving as a control.
- Patients with ICU stays longer than 2 days were monitored for Enterobacteriaceae carriage via gastric and rectal swabs twice weekly.
Main Results:
- Erythromycin-base administration was associated with a significant decrease in rectal carriage of ESBL-producing Enterobacteriaceae (23% vs 10%), particularly Klebsiella pneumoniae (15% vs 2%).
- However, no significant difference in overall intestinal carriage of multiresistant Enterobacteriaceae was observed between the intervention and control bays (28% vs 30%).
- The observed reduction in K. pneumoniae in the intervention bay could not be definitively linked to erythromycin-base due to low numbers in the control bay.
Conclusions:
- Erythromycin-base is not effective in preventing digestive tract carriage of Enterobacteriaceae resistant to third-generation cephalosporins.
- The study did not demonstrate a clear benefit of erythromycin-base for SDD in reducing ESBL-producing Enterobacteriaceae carriage in this ICU population.