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PubMed1996

Serum iodothyronine concentrations in intestinally decontaminated rats treated with a 5'-deiodinase type I inhibitor 6-anilino-2-thiouracil.

Enteric bacteria have been postulated to have a role in thyroid economy by promoting the hydrolysis of thyroid hormone conjugates of biliary origin, thus permitting the absorption and recycling of thyroxine (T4) and triiodothyronine (T3). An enterohepatic circulation of T3 might be more pronounced under conditions in which type I iodothyronine deiodinase activity (5'D-I) is inhibited, because this augments the accumulation of T3 sulfate conjugates in bile. This potential of increased gut reabsorption of T3 might explain, at least in part, the failure of serum T3 values to decrease appreciably when marked reductions in peripheral 5'D-I activity are induced by selenium deficiency or 6-anilino-2-thiouracil (ATU) administration. Thus, studies were performed to determine the effect of intestinal decontamination, in the absence and in the presence of 5'D-I inhibition, on plasma T4 and T3 concentrations. Groups of adult male rats received either enteric antibiotics or no antibiotics for 12 days and then, in half of the rats in each group, treatment for 10 days with ATU, a 5'D-I inhibitor that does not affect thyroid hormone synthesis. The activity of intestinal arylsulfatase and arylsulfotransferase, enzymes that catalyze hydrolysis of thyroid hormone conjugates, was reduced markedly by approximately 87% in rats that received antibiotics, regardless of whether or not they also received ATU. The ATU treatment markedly inhibited liver 5'D-I activity in antibiotic-treated as well as in non-antibiotic-treated rats (control = 399 +/- 32 U/mg protein (mean +/- SEM); ATU = 152 +/- 17: antibiotics = 351 +/- 29; antibiotics + ATU = 130 +/- 10; p < 0.01) and significantly increased plasma T4 and T3 sulfate (T4S, T3S) concentrations (control: T4S = 2.8 +/- 0.4 and T3S = 6.7 +/- 1.3 ng/dl; ATU: T4S = 6.2 +/- 1.4 and T3S = 10.6 +/- 2.1 ng/dl; antibiotics: T4S = 1.8 +/- 0.2 and T3S = 3.6 +/- 1.0 ng/dl; antibiotics + ATU: T4S = 6.8 +/- 0.7 and T3S = 9.7 +/- 1.8 ng/dl; p < 0.05). The ATU treatment was associated with a significant increase in plasma T4 and rT3 concentrations but did not affect plasma T3 concentrations, and intestinal decontamination did not alter these ATU-associated effects on circulating thyroid hormones. These results suggest that anaerobic enteric bacteria in the rat do not have an important role in recycling of thyroid hormones, either under normal conditions or in circumstances where 5'D-I activity is markedly reduced, and that increased gut absorption of T3 from T3S cannot explain the near-normal serum T3 values found when peripheral 5'D-I activity is markedly decreased.

Aniline Compounds↗
PubMed1984

Selective decontamination of alimentary tract microbial flora in patients treated with bone marrow transplantation. A microbiological study.

14 patients undergoing bone marrow transplantation were studied regarding the oral and faecal microflora. Seven patients were given a multidrug regimen, directed against aerobic gram-negative rods and fungi, for local decontamination of the oral cavity and gastrointestinal tract. Seven other patients served as controls. The decontamination regimen was found to decrease the numbers of fungi in the oral cavity and to protect from new colonization. In the gastrointestinal tract aerobic gram-negative rods were eliminated in all patients and new colonization with acquired microorganisms was not observed even when the indigenous anaerobic flora had been disturbed by parenteral antibiotics. In the control group aerobic gram-negative rods and fungi were isolated from all patients during the observation period.

Adolescent↗
PubMed1989

Processes that contribute to radiocesium decontamination of feta cheese.

In a series of experiments, the transfer of radiocesium from ovine milk to feta cheese was investigated through modifications of the standard cheese making procedure. All variations explored showed no significant change in the percentage of radiocesium transfer and the milk-to-cheese transfer coefficient was determined as f=.79 plus/minus .04 L.kg-1. It is concluded that cesium, like the rest of the alkali metals, remains in the water phase and thus follows very closely the distribution of moisture into the products of cheese making. The possibility of radiocesium decontamination of mature feta during the customary storage of the product in brine was also explored in a second series of experiments. The theoretical model employed in the analysis of cesium transport from feta to brine is presented in the Appendix to this paper. Predictions of the model were validated by experiments. A procedure is thus proposed for decontaminating mature feta during storage through successive replacements of the storage medium. Nomograms are presented for the determination of the optimum time interval between changes of the brine and the radiocesium concentration remaining in the feta. Changes in the properties of the product induced by the proposed treatment were also investigated with respect to composition, taste, and overall quality.

Animals↗
PubMedDate not supplied

Selective bowel decontamination with quinolones and nystatin reduces gram-negative and fungal infections in orthotopic liver transplant recipients.

Gram-negative and fungal infections are the most important cause of morbidity and mortality after liver transplantation, especially in the first postoperative month. From February 1989 to February 1990, all liver transplant recipients at The Cleveland Clinic Foundation, Cleveland, Ohio, were placed on a selective bowel decontamination regimen employing oral quinolones and nystatin beginning at the time they were put on the active waiting list for transplantation and continuing until the fourth postoperative week. The incidence of gram-negative and fungal infections for these patients was compared against a historical control group. Selective bowel decontamination was well tolerated and highly effective in reducing early serious gram-negative and fungal infections. This regimen may also reduce mortality.

Adolescent↗
PubMed2001

Coccidial contamination of raspberries: mock contamination with Eimeria acervulina as a model for decontamination treatment studies.

Numerous outbreaks have been reported since 1995 in the United States and Canada that were linked to the consumption of imported fresh raspberries contaminated with Cyclospora. Because Cyclospora has no laboratory animal hosts, Eimeria acervulina, a common chicken coccidium similar in characteristics to Cyclospora, was used as a surrogate to test decontamination treatments. Raspberries were mock contaminated with E. acervulina-sporulated oocysts in a water suspension, then exposed to washing, freezing, heat, or irradiation before they were fed to chicks. The presence of oocysts in the contaminated raspberries was confirmed either by duodenal lesions or oocysts in cecal contents 5 days postinoculation (PI) or in fecal contents 6 days PI, after 24 h of fecal collection. Washing of raspberries was generally not adequate in removing coccidial contamination, but freezing and heat treatment appeared effective. Gamma irradiation of E. acervulina-sporulated oocysts at a dose of 0.5 kGy was partially effective, but it was completely effective at 1.0 kGy and higher. We suggest that E. acervulina, for mock contamination of raspberries and subsequent decontamination treatments, is easy to handle, safe, and economical to study.

Animals↗
PubMed2001

Decontamination of lettuce using acidic electrolyzed water.

The disinfectant effect of acidic electrolyzed water (AcEW), ozonated water, and sodium hypochlorite (NaOCl) solution on lettuce was examined. AcEW (pH 2.6; oxidation reduction potential, 1140 mV; 30 ppm of available chlorine) and NaOCl solution (150 ppm of available chlorine) reduced viable aerobes in lettuce by 2 log CFU/g within 10 min. For lettuce washed in alkaline electrolyzed water (AIEW) for 1 min and then disinfected in AcEW for 1 min, viable aerobes were reduced by 2 log CFU/g. On the other hand, ozonated water containing 5 ppm of ozone reduced viable aerobes in lettuce 1.5 log CFU/g within 10 min. It was discovered that AcEW showed a higher disinfectant effect than did ozonated water significantly at P < 0.05. It was confirmed by swabbing test that AcEW, ozonated water, and NaOCI solution removed aerobic bacteria, coliform bacteria, molds, and yeasts on the surface of lettuce. Therefore, residual microorganisms after the decontamination of lettuce were either in the inside of the cellular tissue, such as the stomata, or making biofilm on the surface of lettuce. Biofilms were observed by a scanning electron microscope on the surface of the lettuce treated with AcEW. Moreover, it was shown that the spores of bacteria on the surface were not removed by any treatment in this study. However, it was also observed that the surface structure of lettuce was not damaged by any treatment in this study. Thus, the use of AcEW for decontamination of fresh lettuce was suggested to be an effective means of controlling microorganisms.

Bacteria, Aerobic↗
PubMed2002

Effect of acid adaptation on survival of Escherichia coli O157:H7 in meat decontamination washing fluids and potential effects of organic acid interventions on the microbial ecology of the meat plant environment.

The acid tolerance of Escherichia coli O157:H7 may be pH inducible. Correspondingly, organic acid meat decontamination washing fluids may enhance the establishment of acid-adapted E. coli O157:H7 strains in packing plants, especially in mixtures with water washings from meat that may be of sublethal pH. Acid-adapted and nonadapted cultures of a rifampin-resistant derivative of the acid-resistant E. coli O157:H7 strain ATCC 43895 were tested to evaluate their survival in meat-washing fluids over a wide pH range. The cultures were exposed (10(5) CFU/ml) to acidic (2% lactic acid. 2% acetic acid, or a mixture of the two with water washings at ratios of 1/1, 1/9, or 1/99 [vol/vol]) or nonacid (water) meat washings for up to 14 days at 4 or 10 degrees C storage. E. coli O157:H7 survived in water washings, but the low storage temperatures and predominant natural microbiota synergistically inhibited its growth. Compared with acid-adapted populations, nonadapted populations displayed greater potential for survival and a tendency to initiate growth in water meat washings at 10 degrees C. The pathogen survived in most of the acid washings throughout storage (14 days), sometimes with minimal population reductions. Overall. nonadapted populations declined faster than acid-adapted populations, while the declines increased as the acid concentration and temperature of storage increased and were more dramatic in lactate, compared to acetate, washings. Acid-containing washings were selective for growth of lactic acid bacteria and yeasts. indicating that organic acid treatments may alter the microbial ecology of meat plant environments and potentially that of the meat. These results should be considered when selecting decontamination technologies for meat.

Acetic Acid↗
PubMed2002

Decontaminative effect of frozen acidic electrolyzed water on lettuce.

We investigated the effects of frozen acidic electrolyzed water (AcEW) on lettuce during storage in a styrene-foam container. The lettuce was kept at 2 to 3 degrees C for 24 h. Populations of aerobic bacteria associated with lettuce packed in frozen AcEW were reduced by 1.5 log CFU/g after storage for 24 h. With frozen tap water, no microorganism populations tested in this study were reduced. A frozen mixture of AcEW and alkaline electrolyzed water (AlEW) also failed to reduce populations of microorganisms associated with lettuce. Although chlorine gas was produced by frozen AcEW, it was not produced by the AcEW-AlEW mixture. This result indicates that the main factor in the decontaminative effect of frozen AcEW was the production of chlorine gas. Accordingly, low-temperature storage and decontamination could be achieved simultaneously with frozen AcEW during distribution.

Bacteria, Aerobic↗
PubMed2003

Influence of extended acid stressing in fresh beef decontamination runoff fluids on sanitizer resistance of acid-adapted Escherichia coli O157:H7 in biofilms.

This study evaluated resistance to sanitizing solutions of Escherichia coli O157:H7 cells forming biofilms on stainless steel coupons exposed to inoculated meat decontamination runoff fluids (washings). A previously acid-adapted culture of a rifampicin-resistant derivative of E. coli O157:H7 strain ATCC 43895 was inoculated in unsterilized or sterilized combined hot-water (85 degrees C) and cold-water (10 degrees C) (50/50 [vol/vol]) composite water (W) washings (pH 6.29 to 6.47) and in W washings mixed with 2% acetic acid (pH 4.60 to 4.71) or in 2% lactic acid W washings (pH 4.33 to 4.48) at a ratio of 1/99 (vol/vol). Stainless steel coupons (2 by 5 by 0.08 cm) were submerged in the inoculated washings and stored for up to 14 days at 15 degrees C. Survival of E. coli O157:H7 was determined after exposure (0 to 60 s for cells in suspension and 0 to 300 s for attached cells) to two commercial sanitizers (150 ppm peroxyacetic acid and 200 ppm quaternary ammonium compound) at 2, 7, and 14 days. E. coli O157:H7 attached more rapidly to coupons submerged in washings containing the natural flora than to those without. The attached cells were more resistant to the effects of the sanitizers than were the cells in suspension, and survival was highest in the presence of the natural flora. Attached cells in the presence of dilute acid washings were more sensitive to subsequent sanitizer treatments than were cells generated in the presence of W washings. Under the conditions of this study, cells of E. coli O157:H7 in W washings were more sensitive to acidic (peroxyacetic acid) than to alkaline (quaternary ammonium) sanitizers during storage. These results suggest that meat processing plants that apply no decontamination or that use only water washings of meat should consider using acidic sanitizers to enhance biofilm removal. Plants that apply both water and acidic washings may create a sublethal acid-stressing environment in the runoff fluids, sensitizing biofilm cells to subsequent sanitizing treatments.

Acetic Acid↗
PubMed2003

Effects of spray-cooling processes on the microbiological conditions of decontaminated beef carcasses.

Spray processes for cooling decontaminated carcasses were examined at four beef packing plants. Temperature histories were collected from deep leg sites on 25 carcasses and from randomly selected sites on the surfaces of a further 25 carcasses selected at random from carcasses undergoing cooling at each plant. Carcass cooling rates were similar at all four plants. Proliferation values calculated from surface temperature histories indicated similar increases of < or = 2 log units in the numbers of pseudomonads on carcasses at all plants and increases of <0.5 and >0.5 log units in the numbers of Escherichia coli on carcasses at plants A and B and plants C and D, respectively. The numbers of aerobes recovered from carcasses after cooling were about 1 log unit larger than the numbers recovered from carcasses before cooling at plants A, B, and C but >1.5 log units larger at plant D. These increases in numbers of aerobes were in agreement with the estimated proliferations of pseudomonads. The larger increase in the number of aerobes on carcasses at plant D may be attributable to carcasses not being pasteurized at that plant, while carcasses were pasteurized at all of the other plants. The numbers of E. coli recovered from carcasses after cooling at plants B, C, and D were also in agreement with the increases calculated from surface temperature histories. However, numbers of E. coli declined by about 1 log unit during carcass cooling at plant A. This decline may have been due to death occurring during chilling for some E. coli cells that were injured rather than killed by pasteurization with sprayed hot water at plant A, whereas pasteurization with steam at plants B and C seemingly left few injured E. coli cells. The growth of bacteria on decontaminated carcasses during spray cooling at the four plants was apparently constrained by temperature alone.

Animals↗
PubMed2004

Acid tolerance of acid-adapted and nonadapted Escherichia coli O157:H7 following habituation (10 degrees C) in fresh beef decontamination runoff fluids of different pH values.

This study evaluated survival of Escherichia coli O157:H7 strain ATCC 43895 during exposure to pH 3.5 following its habituation for 2 or 7 days at 10 degrees in fresh beef decontamination waste runoff fluid mixtures (washings) containing 0, 0.02, or 0.2% of lactic or acetic acids. Meat washings and sterile water (control) were initially inoculated with approximately 5 log CFU/ml of acid- and nonadapted E. coli O157:H7 cells cultured (30 degrees C, 24 h) in broth with and without 1% glucose, respectively. After 2 days, E. coli O157:H7 survivors from acetate washings (pH 3.7 to 4.7) survived at pH 3.5 better than E. coli O157:H7 survivors from lactate washings (pH 3.1 to 4.6), especially when the original inoculum was acid adapted. Also, although E. coli O157:H7 habituated in sterile water for 2 days survived well at pH 3.5, the corresponding survivors from nonacid water meat washings (pH 6.8) were rapidly killed at pH 3.5, irrespective of acid adaptation. After 7 days, E. coli O157:H7 survivors from acetate washings (pH 3.6 to 4.7) continued to resist pH 3.5, whereas those from lactate washings died off. This loss of acid tolerance by E. coli O157:H7 was due to either its low survival in 0.2% lactate washings (pH 3.1) or its acid sensitization in 0.02% lactate washings, in which a Pseudomonas-like natural flora showed extensive growth (> 8 log CFU/ml) and the pH increased to 6.5 to 6.6. Acid-adapted E. coli O157:H7 populations habituated in water washings (pH 7.1 to 7.3) for 7 days continued to be acid sensitive, whereas nonadapted populations increased their acid tolerance, a response merely correlated with their slight (< 1 log) growth at 10 degrees C. These results indicate that the expression of high acid tolerance by acid-adapted E. coli O157:H7 can be maintained or enhanced in acid-diluted meat decontamination waste runoff fluids of pH levels that could permit long-term survival at 10 degrees C. Previous acid adaptation, however, could reduce the growth potential of E. coli O157:H7 at 10 degrees C in nonacid waste fluids of high pH and enriched in natural flora. These conditions might further induce an acid sensitization to stationary E. coli O157:H7 cells.

Adaptation, Physiological↗
PubMed2005

Development and evaluation of an on-line hide decontamination procedure for use in a commercial beef processing plantt.

The hides of cattle are the source of Escherichia coli O157:H7 that contaminates beef carcasses during commercial beef processing. Therefore, effective interventions that reduce hide contamination should reduce subsequent carcass contamination. The first objective of this study was to identify the most effective reagents for decontamination of beef hides. Cattle hides draped over barrels were used for in vitro experiments to compare the efficacy of washes using 1.6% sodium hydroxide, 4% trisodium phosphate, 4% chlorofoam, or 4% phosphoric acid, each followed by a rinse step using either water or acidified (pH 7.0) chlorine at 200 or 500 ppm. All treatments using a water rinse reduced hide coliform counts by 1.5 to 2.5 log CFU/ 100 cm2. Compared with water rinses, 200 and 500 ppm acidified chlorine rinses increased efficacy by approximately 1.0 and 2.0 log CFU/100 cm2, respectively. Vacuuming of the treated areas to remove excess liquid improved hide cleanliness by an average of an additional 1.0 log CFU/100 cm2. The second objective was to evaluate the use of an on-line hide-wash cabinet that used a sodium hydroxide wash and a chlorinated (1 ppm) water rinse. Hides sampled before entering and after exiting the cabinet had aerobic plate counts and Enterobacteriaceae counts that were reduced by 2.1 and 3.4 log CFU/100 cm2, respectively, and the prevalence of E. coli O157 on hides was reduced from 44 to 17% when the cabinet was in use. Preevisceration carcass aerobic plate counts and Enterobacteriaceae counts were both reduced by 0.8 log CFU/100 cm2, and the prevalence of E. coli O157 on preevisceration carcasses was reduced from 17 to 2% when the cabinet was in use. These results support decontamination of hides as an effective means to reduce pathogen contamination of cattle carcasses during processing.

Abattoirs↗
PubMed2005

Efficacy of ozonated and electrolyzed oxidative waters to decontaminate hides of cattle before slaughter.

The hides of cattle are the primary source of pathogens such as Escherichia coli O157:H7 that contaminate preevisceration carcasses during commercial beef processing. A number of interventions that reduce hide contamination and subsequent carcass contamination are currently being developed. The objective of this study was to determine the efficacy of ozonated and electrolyzed oxidizing (EO) waters to decontaminate beef hides and to compare these treatments with similar washing in water without the active antimicrobial compounds. Cattle hides draped over barrels were used as the model system. Ozonated water (2 ppm) was applied at 4,800 kPa (700 lb in2) and 15 degrees C for 10 s. Alkaline EO water and acidic EO water were sequentially applied at 60 degrees C for 10 s at 4,800 and 1,700 kPa (250 lb in2), respectively. Treatment using ozonated water reduced hide aerobic plate counts by 2.1 log CFU/100 cm2 and reduced Enterobacteriaceae counts by 3.4 log CFU/100 cm2. EO water treatment reduced aerobic plate counts by 3.5 log CFU/100 cm2 and reduced Enterobacteriaceae counts by 4.3 log CFU/100 cm2. Water controls that matched the wash conditions of the ozonated and EO treatments reduced aerobic plate counts by only 0.5 and 1.0 log CFU/100 cm2, respectively, and each reduced Enterobacteriaceae counts by 0.9 log CFU/100 cm2. The prevalence of E. coli O157 on hides was reduced from 89 to 31% following treatment with ozonated water and from 82 to 35% following EO water treatment. Control wash treatments had no significant effect on the prevalence of E. coli O157:H7. These results demonstrate that ozonated and EO waters can be used to decontaminate hides during processing and may be viable treatments for significantly reducing pathogen loads on beef hides, thereby reducing pathogens on beef carcasses.

Abattoirs↗
PubMedDate not supplied

Hand decontamination.

Hand decontamination is an important intervention in controlling hospital-acquired infections. Dinah Gould examines the issues relating to this, including different decontaminants, the evidence base, the need for improvements in practice, and effective practice.

Antisepsis↗
PubMed1999

Effect of heat and acid decontamination treatments on the recovery of Legionella pneumophila from drinking water using two selective media.

Two different decontamination systems, heat and acid, and two isolation media, GVPC and MWY agar were tested for the recovery of Legionella pneumophila from drinking water. The samples were concentrated by filtration through 0.2 micron polyamide filter and the membranes were resuspended in the original water samples. The suspension was divided into three parts: the first was placed in a 50 degrees C water bath, the second was acidified in HCl-KCl solution and the third did not undergo any treatment. The isolation was made by means of media containing charcoal, yeast extract and glycine with cycloeximide (GVPC) or vancomycin, polimixin B, anysomicin and dyes (MWY). Heating at 50 degrees C for 30 minutes was seen to be the best decontamination system above all when used with GVPC agar. Moreover, with this pretreatment higher counts were obtained both on MWY and GVPC agar. The MWY agar produced the highest isolatin percentages and the highest counts.

Acids↗
PubMed1999

[Evaluation of a fully automated mycobacteria culture system, MB/BacT using a newly developed digestion-decontamination procedure, semi-alkaline protease-N-acetyl-L-cysteine-NaOH (SAP-NALC-NaOH) method].

A fully automated non-radiometric mycobacteria culture system, MB/BacT (Organon Teknika, Durham, NC, U.S.A.), was recently introduced in Japan and evaluated for its ability to detect mycobacteria in clinical sputum specimens. A previous study yielded nearly a 40% contamination ratio from sputa treated with the standard N-acetyl-L-cysteine (NALC)-NaOH method. This study employed a mucolytic agent (semi-alkaline protease; SAP) in which the sputa were processed twice for digestion followed by decontamination at twice the standard volume of NALC-NaOH. The concentrated sediments were resuspended in phosphate buffer (0.067 M, pH 6.8), and inoculated into the MB/BacT Process Bottles supplemented with antibiotics. The bottles were incubated at 37 degrees C and monitored for up to fifty-six days. Recovery of mycobacteria was compared in three different egg-based Ogawa media in addition to a non-selective Middlebrook 7H10 agar. A total of 1, 124 clinical sputum specimens have been evaluated. Of these, 464 were positive for growth of mycobacteria, of which 447 (96.3%) were positive by the MB/BacT. False-positive alarms due to break through contamination, mainly by Pseudomonas aeruginosa and Candida spp., were observed in twenty-one specimens (1.9%). The three Ogawa media could detect only 283 (60.5%) to 353 (75.4%) positives, and Middlebrook 7H10 agar only 424 (90.6%) positives. The time to detect positive cultures of Mycobacterium tuberculosis complex by the MB/BacT ranged from 2.2 days to 52.3 days, and 50% of positive cultures were detected within 16.7 days of incubation. It can be concluded that the combination of SAP-NALC-NaOH digestion-decontamination procedure and the MB/BacT is particularly useful for the isolation of mycobacteria and has a faster time to detect than conventional methods. MB/BacT is a suitable alternative method for the detection of mycobacteria in Japan, where the radiometric Bactec System is not available.

Acetylcysteine↗
PubMed2000

[Effectiveness of combined vancomycin and pefloxacine in gastrointestinal decontamination for preventing infections after chemotherapy-induced bone marrow aplasia. A randomized double-blind study].

OBJECTIVE: To test the value of the combination of pefloxacin and vancomycin as gastro-intestinal tract decontamination for the prevention of infections in patients with chemotherapy-induced neutropenia. PATIENTS AND METHODS: Oral pefloxacin plus vancomycin (48 patients), pefloxacin alone (51 patients), or placebo (52 patients) were administered in a randomized double-blind study. Evaluation was done by determining site and documentation of infections, organisms responsible for bacteriologically documented infections, organisms acquired in surveillance cultures and number of days with fever during aplasia. RESULTS: Patients receiving pefloxacin had significantly fewer episodes of bacteremia with enterobacteriacae. No differences were noted between patients treated by pefloxacin and those who received a combination of pefloxacin with vancomycin regarding gram-positive (Gram+) infections and infections with gram-negative (Gram-) organisms usually resistant to pefloxacin. However, placebo gave similar results. There was no induction of resistance to pefloxacin during the study. Tolerance of treatment was excellent. Only a prolonged aplasia has been observed in patients receiving pefloxacin. CONCLUSION: Thus, the combination of vancomycin with pefloxacin was not more efficacious than pefloxacin only for the prevention of Gram+ infections in the neutropenic patient. The systematic use of antibiotics as gastrointestinal tract decontamination for the prevention of infections in patients with aplasia may be questionable.

Adult↗