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PubMed2006

Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial.

CONTEXT: Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections. OBJECTIVE: To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12% chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: A prospective, randomized, double-blind, placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands, between August 1, 2003, and September 1, 2005. Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval, 954 were eligible for analysis. INTERVENTION: Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo. MAIN OUTCOME MEASURES: Incidence of nosocomial infection, in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay. RESULTS: The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8% and 26.2%, respectively (absolute risk reduction [ARR], 6.4%; 95% confidence interval [CI], 1.1%-11.7%; P = .002). In particular, lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002; and 3.2%; 95% CI, 0.9%-5.5%; P = .002, respectively). For the prevention of 1 nosocomial infection, 16 patients needed to be treated with chlorhexidine gluconate. A significant reduction of 57.5% in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1% in the placebo group (P<.001). Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group (ARR, 0.8 days; 95% CI, 0.24-1.88; P = .04). CONCLUSION: Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00272675.

Administration, Intranasal↗
PubMed1998

Bacterial decontamination of blood stem cell apheresis products.

High-dose chemotherapy using autologous bone marrow or mobilized blood as the source of stem cells for haematologic rescue, is being widely used for a variety of haematological malignancies and solid tumours. To collect sufficient numbers of haematopoietic stem cells for successful engraftment, standard apheresis procedures are performed. Newer techniques and refinements of the procedure allow using only 1 to 2 apheresis products (AP) for autografting. Bacterial contamination of the AP, although very rare, sometimes occurs and may lead to generalized infection in the recipient. The apheresis must be repeated, sometimes even including time-consuming and costly mobilization. At our institution, the patients' blood stem cells are usually mobilized with chemotherapy followed by daily s.c. haematopoietic growth factor injections or with growth factor alone. An apheresis machine is used for collection through a central venous line and the AP is routinely checked for bacterial contamination. Results are only available after the product has been processed and cryopreserved. In the last 5 years, we observed bacterial contamination in four of our AP. Therefore, we investigated the possibility of in vitro antibiotic decontamination. Using standard antibiograms, we determined the sensitivities of the contaminating bacteria. By incubating the products with the specific antibiotics at bactericidal concentrations, we were able to sterilize the probes from the contaminating bacteria. In the concurrently performed controls without the active substance, bacteria were still detectable. We conclude that in selected cases, in vitro decontamination using pretested antibiotics, may be a feasible, cost-effective, and easy alternative to performing additional apheresis procedures.

Anti-Bacterial Agents↗
PubMed1990

Selective intestinal decontamination increases serum and ascitic fluid C3 levels in cirrhosis.

Selective intestinal decontamination for 7 days with norfloxacin was performed in 14 cirrhotic patients with ascites and low ascitic fluid total protein. Variations in serum and ascitic fluid of C3 and C4 and ascitic fluid total protein after therapy were compared with those of a control group of 14 untreated patients with similar characteristics. After oral norfloxacin administration, we saw a significant increase of C3 in serum (p less than 0.05) and ascitic fluid (p = 0.01). A significant increase was also observed in ascitic fluid total protein (p less than 0.05) but not in serum and ascitic fluid C4. There were no changes in serum C3, ascitic fluid C3, ascitic fluid C4 or in ascitic fluid total protein in group 2. These data demonstrate that selective intestinal decontamination increases serum and ascitic fluid C3 levels and, therefore, might be useful in preventing spontaneous infections in cirrhotic patients at high risk of infection.

Ascitic Fluid↗
PubMedDate not supplied

Decontamination of vinyl urinary drainage bags with bleach.

The purpose of the study described here was to investigate whether vinyl urinary leg and bed bags used for a 4-week period in the acute rehabilitation setting could be safely reused after having been decontaminated daily with a diluted bleach rinse. Rehabilitation patients who had bladder dysfunction and used vinyl urinary drainage bags (N = 88) were randomly assigned to control (C) and experimental (E) groups; 54 patients completed the study. Group C's bags were replaced weekly; group E's were replaced after 4 weeks. The bags of patients in both groups were decontaminated in identical fashion each day. On the patient's admission to the study, a baseline assessment was completed, a urine culture was obtained, and sterile drainage equipment was provided. Each week for 4 weeks, urine and bag characteristics and signs and symptoms of urinary tract infection were noted. No statistically significant differences (p < .5) were found between the groups. There were no clinical signs of infection requiring treatment, no changes in bag appearance or integrity, and no infection outbreaks associated with a single urinary tract pathogen that would indicate cross-contamination.

Colony Count, Microbial↗
PubMed2002

Effect of simulated CO2 and GaAlAs laser surface decontamination on temperature changes in Ti-plasma sprayed dental implants.

BACKGROUND AND OBJECTIVE: To investigate and compare temperature elevations at the implant-bone interface during simulated implant surface decontamination with a CO2 and a GaAlAs laser. STUDY DESIGN/MATERIALS AND METHODS: Stepped cylinder implants (Frialit 2) Friadent GmbH, Mannheim, Germany) with a Titanium plasma sprayed surface were inserted into bone blocks cut from pig femurs. An artificial periimplant bone defect provided access for laser irradiation in the coronal third. Both lasers were operated at 1.0-2.5 W in the cw-mode. The bone block was placed into a 37 degrees C water bath in order to simulate in vivo thermal conductivity and diffusitivity of heat. K-type thermocouples connected to a digital meter were used to register temperature changes at the periimplant bone. RESULTS: In mean, the critical threshold of 47 degrees C was exceeded after 8 seconds at a power output of 2.5 W, 13 seconds at 2.0 W, 18 seconds at 1.5 W, and 42 seconds at 1.0 W with the GaAlAs laser and 15 seconds (2.5 W), 23 seconds (2.0 W), 35 seconds (1.5 W), and 56 seconds (1.0 W) with the CO2 laser. At equal energy fluence, GaAlAs laser irradiation induced significantly higher temperature elevations than CO2 laser irradiation. CONCLUSIONS: In an energy dependent manner implant surface decontamination with both laser types must be limited in time to allow the implant and bone to cool down. Clinical guidelines are presented to avoid tissue damage.

Animals↗
PubMed1982

The screening of four aminoglycosides in the selective decontamination of the digestive tract in mice.

The suppressive effect of amikacin, gentamicin, tobramycin and paromomycin on the aerobic endogenous flora and on the colonization resistance of the digestive tract was tested by administering one of the antibiotics orally at five different dose levels. At a certain dose level, all antibiotics suppressed the endogenous Enterobacteriaceae species. Amikacin was particularly effective in this respect. Low doses of amikacin rapidly destroyed the colonization resistance. This resistance only remained unaffected in animals treated with tobramycin in doses that were still adequate to completely suppress the endogenous Enterobacteriaceae species. We concluded that of all the antibiotics tested in this study, only tobramycin may have a future in (clinical) application for the selective decontamination of the digestive tract. Selective decontamination can be considered an effective method for infection prevention in leukopenic patients.

Amikacin↗
PubMed1988

Infections after experimental cadaver bone marrow transplantation in beagle dogs. Transplantations with and without selective gastrointestinal decontamination.

Experimental transplantations of cadaver bone marrow (BMT) in beagle dogs were performed to evaluate the problems and potentials in a preclinical setting. The effectiveness of selective decontamination of the gut (SD) and gnotobiotic surveillance in preventing infections during longer aplastic periods was investigated. Three groups of dogs were compared. Group A: controls. Group B: dogs with BMT, without SD and irregular gnotobiotic surveillance. Group C: dogs with BMT, with SD and regular gnotobiotic surveillance. The intestinal colonization of normal healthy beagles shows similarities as well as dissimilarities to the human intestinal microflora. Aerobic potentially pathogenic organisms do not colonize the gut of healthy beagles under our keeping conditions. SD resulted in a significant decrease in infections with Escherichia coli and Plesiomonas. Infections with anaerobes, as well as bacterial infections of the respiratory tract were, however, not prevented. The intestinal colonization in dogs of group C with Clostridium difficile is another obvious effect of SD. The infections encountered during the study indicate the importance of the "take" for the clinical significance and outcome of intestinal colonization with potentially pathogenic organisms. In order to reduce the drug burden of BMT patients, we consider the elimination of routine SD after BMT not to be superior to gnotobiotic surveillance and germ-specific short term decontamination.

Amphotericin B↗
PubMedDate not supplied

Comparison between two non-absorbable antibiotic regimens for decontamination of the oropharynx.

Fourteen healthy individuals were studied regarding the oropharyngeal microflora. Seven subjects were given a non-absorbable multi-drug regimen, consisting of 1% polymyxin B, 3% neomycin and 3% amphotericin B, that was directed against aerobic gram-negative rods and fungi for local decontamination of the oropharynx. Seven others were given another multi-drug regimen consisting of 1% polymyxin B, 1% neomycin, 3% amphotericin B and 0.5% vancomycin, that also included an agent directed against gram-positive bacteria. Both decontamination regimens were found to protect from new colonization with fungi and gram-negative rods in the oropharynx. Suppression of gram-positive cocci was only observed in those subjects receiving the regimen containing vancomycin.

Adult↗
PubMed1996

Prevention of infection in children with acute leukaemia. No major difference between total and selective bowel decontamination.

To evaluate the effect of total bowel decontamination (TD) and selective bowel decontamination (SD) in a non-protective environment clinical and laboratory data of children treated for acute leukaemia between 1983 and 1991 were analysed retrospectively. From 1983 until 1989 34 patients [18 acute non-lymphoblastic leukaemia (ANLL) patients, 16 acute lymphoblastic leukaemia (ALL) patients] received TD and 31 patients (8 ANLL patients, 23 ALL patients) received SD from 1987 until 1991. TD consisted of colistin sulphate, neomycin, cephaloridine and amphotericin B orally as well as Orabase and sterilized food, while the patients were nursed in a single room. SD consisted of oral colistin sulphate, neomycin and amphotericin B. Those patients with ANLL were nursed in a single room; patients with ALL were nursed in a single room during remission induction therapy only. All patients except those with ANLL receiving TD received Pneumocystis carinii pneumonia prophylaxis with cotrimoxazole. Because the two groups were heterogeneous for diagnosis and chemotherapy the occurrence of fever (central body temperature at least 38.5 degrees C) and major infections (septicaemia of infections of the deep tissues or organs) were registered during periods of neutropenia (neutrophilic granulocytes < or = 500/mm3 for at least 8 days). Patients on TD had 55 periods of neutropenia, patients on SD 80. Patients on TD had 89.1 periods of fever/100 periods of neutropenia whereas patients on SD had 56.3. Also patients on TD had 27.3 major infections/100 periods of neutropenia whereas patients on SD had 11.3. Major infections predominantly consisted of septicaemia caused by gram-positive bacteria. We conclude that, in this study, TD in a non-protective environment does not offer better protection against major infections that SD in patients with ALL or ANLL.

Adolescent↗
PubMed1990

Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection.

Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections. These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections. We randomised prospectively 114 patients into a test group receiving SD-medication (n = 56) and a control group receiving conventional prophylaxis. Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated. The preoperative administration of SD-medication resulted in adequate decontamination within 3-4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively. Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications. This indicates that prolonged use in these patients might be beneficial. This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.

Anti-Bacterial Agents↗
PubMed1981

[Comparative study on the value of selective decontamination of the digestive tract in acute leukemia patients (author's transl)].

A comparative study of infectious morbidity and mortality in neutropenic patients with acute leukemia receiving chemotherapy was undertaken to test the effects of a suppression of endogenous and ambient microorganisms. Patients were allocated to receive [1] oral antibiotics (neomycin, colistin, and nystatin) in conventional ward isolation; [2] no antimicrobial suppression but conventional ward isolation; [3] strict isolation, filtered air, sterilized food and oral antibiotics. Significantly fewer infections with Gram-negative bacilli were seen in patients with strict isolation plus endogenous microbial suppression versus patients receiving selective gut decontamination versus patients without nonabsorbable antibiotics in simple reverse isolation. The death rate from infection was significantly reduced in patients who received antibiotics for gut flora suppression in conventional ward isolation compared with the corresponding control group. In addition, a significant improvement of leukemic remission rate was seen in this group. The protocol for decontamination was well tolerated.

Adolescent↗
PubMed1990

Low-dose ciprofloxacin for selective decontamination of the digestive tract in human volunteers.

The effect on the faecal aerobic and anaerobic flora of ciprofloxacin given in low doses for selective decontamination of the digestive tract was investigated in ten human volunteers. The volunteers received 50, 100 and 200 mg of ciprofloxacin every 12 h for five days at intervals of three and five weeks respectively. No significant differences in the numbers of aerobes or anaerobes were seen after the 2 x 50 mg regime. The colony counts of most anaerobes and the total aerobe count were significantly decreased after the 2 x 100 mg [corrected] regime. Whereas the aerobe count was also significantly decreased after administration of 2 x 200 mg, the anaerobe count remained stable. Clostridium difficile was not detected during or after treatment. From these results it can be concluded that ciprofloxacin in a dose of 2 x 200 mg [corrected] can be recommended for selective decontamination of the digestive tract.

Bacteria↗
PubMed1993

Influence of selective decontamination of the digestive tract on microbial biofilm formation on endotracheal tubes from artificially ventilated patients.

The effect of selective decontamination of the digestive tract on the nature and incidence of microbial biofilm formation on endotracheal tubes was assessed. Thirty endotracheal tubes were obtained post-extubation from patients in the intensive care unit who had been ventilated for a 1 to 15 day period and who did or did not receive the antibiotic regimen. Extensive biofilm formation was identified by scanning electron microscopy on 97% of tubes examined. Endotracheal tube biofilm in tubes obtained from patients who received selective decontamination of the digestive tract showed a high prevalence of colonization with yeast (4 of 15 tubes) and gram-positive bacteria (streptococci, staphylococci and diphtheroids) (14 of 15 tubes). Staphylococcus aureus was isolated only from this group. Pseudomonas spp. were isolated from 2 of 15 tubes in both patient groups. Enteric gram-negative organisms (coliforms, Klebsiella and Proteus spp.) were isolated only from tubes of patients who did not receive the antibiotic regimen (4 of 15 tubes). Yeasts, however, were not isolated from these tubes. Group D streptococcal isolates were resistant to tobramycin as were half of the Staphylococcus aureus isolates. For gram-negative bacteria, the MIC of tobramycin was in the range 1-64 micrograms/ml and the MIC of polymyxin in the range 0.5-16 micrograms/ml. Although a reduction was observed in the incidence of gram-negative microorganisms, this antibiotic regimen does not inhibit biofilm formation on the endotracheal tube by other pathogens associated with pneumonia in ventilated patients. This persistent nidus may be a factor in the pathogenesis of nosocomial pneumonia.

Adolescent↗
PubMed2003

Phytoremediation: an overview of metallic ion decontamination from soil.

In recent years, phytoremediation has emerged as a promising ecoremediation technology, particularly for soil and water cleanup of large volumes of contaminated sites. The exploitation of plants to remediate soils contaminated with trace elements could provide a cheap and sustainable technology for bioremediation. Many modern tools and analytical devices have provided insight into the selection and optimization of the remediation process by plant species. This review describes certain factors for the phytoremediation of metal ion decontamination and various aspects of plant metabolism during metallic decontamination. Metal-hyperaccumulating plants, desirable for heavily polluted environments, can be developed by the introduction of novel traits into high biomass plants in a transgenic approach, which is a promising strategy for the development of effective phytoremediation technology. The genetic manipulation of a phytoremediator plant needs a number of optimization processes, including mobilization of trace elements/metal ions, their uptake into the root, stem and other viable parts of the plant and their detoxification and allocation within the plant. This upcoming science is expanding as technology continues to offer new, low-cost remediation options.

Biodegradation, Environmental↗
PubMed1987

Effect of inoculum size on in vitro activity of norfloxacin against fecal anaerobic bacteria. Rationale for selective decontamination of the digestive tract.

Previous studies have shown that anaerobic bacteria are susceptible to norfloxacin at the levels attained in the feces. Conversely, studies in laboratory animals and neutropenic humans using norfloxacin for selective decontamination of the digestive tract have shown that norfloxacin markedly reduces the aerobic enteric flora without reducing fecal anaerobic flora. In an effort to resolve this paradox, the effect of a 10(9) colony-forming units (cfu)/ml inoculum, which is more reflective of actual fecal counts than the standard 10(5) cfu/ml inoculum, on the activity of norfloxacin against two fecal Escherichia coli isolates and 16 fecal anaerobic isolates was studied. The results showed a marked inoculum effect at 10(9) cfu/ml for most anaerobic isolates but not for the E. coli strains tested. At 256 micrograms/ml, all E. coli were killed while the anaerobic bacteria maintained colony counts greater than or equal to 10(9) cfu/ml. Hence, the lack of anaerobic activity (minimal inhibitory concentration greater than or equal to 512 micrograms/ml) at higher fecal inocula might explain the utility of norfloxacin in selective decontamination of the bowel.

Adult↗
PubMed1989

A study of radiocesium contamination and decontamination of sheep's milk.

The radiocesium contamination and decontamination of sheep's milk were studied under a constant level of activity concentration in the sheep's diet. Two sets of experiments were performed: one at the end of the animal's lactating period and one during the main lactating period. The data were in satisfactory agreement with the predictions of a simple two-compartment model. At the stage of equilibrium the data yielded the transfer coefficient fm with an average value of fm = 0.063 +/- 0.005 d L-1. In the second experiment a detailed study of the decontamination phase revealed a two-component decay with amplitudes 53% and 43% and half-lives 1.5 d and 6.9 d, respectively. A small 4% long-lived (T1/2 = 170 d) third component could not be distinguished from an overall background decay, measured in control animals.

Animal Feed↗
PubMed1990

Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection.

181 patients undergoing resection of the oesophagus for carcinoma were randomised to receive selective decontamination (test group) or conventional perioperative antibiotic prophylaxis (controls). 114 patients were finally included in the study: 12 of 56 test patients had 18 infections, whereas 32 of 58 controls acquired 51 infections. Colonisation with aerobic gram-negative microorganisms, and the number of postoperative respiratory tract infections were significantly lower in the test patients. The postoperative therapeutic use of antibiotics was significantly lower in the test group. No endogenous infections were caused by gram-negative bacilli in the test group. Selective decontamination reduces colonisation with gram-negative bacilli and postoperative infections after resection of the oesophagus.

Adult↗
PubMed1988

Bacteriological quality of broiler carcasses as affected by in-plant lactic acid decontamination.

In an attempt to improve the bacteriological quality of broiler carcasses the bactericidal effect of treatments with 1% and 2% lactic acid was investigated. Bacterial colonisation was determined immediately after treatment, after the carcasses had been chilled and during storage at 0 degrees C. Examination included numbers of mesophilic aerobic and psychrotrophic aerobic colony-forming units (CFU), CFU of Enterobacteriaceae at 37 degrees C and CFU of Staphylococcus aureus. Immediately after treatment colonisation per gram skin was generally reduced by about 1 log. Initially 2% lactic acid was not found significantly more effective in reducing colony counts than 1%. However, treatment with 2% lactic acid suppressed post-decontamination colonisation with Enterobacteriaceae more effectively than 1% lactic acid, as determined after 15-18 days storage at about 0 degrees C. Lactic acid treatment was most effective when applied shortly before chilling. Successive treatment at three different stages during slaughtering did not increase reduction of colony counts. It is concluded that decontamination with 1-2% lactic acid at pH 2, when applied shortly before chilling, will markedly improve the bacterial safety and increase the refrigerated shelf life of broiler carcasses.

Animals↗