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PubMed1990

[The effect of selective decontamination on nosocomial infections, their causative agents and antibiotic resistance in long-term intubated intensive care patients].

During a 12-month period 45 long-term intubated patients were treated by topical application of non-absorbable antibiotics (tobramycin, polymyxin, amphotericin B) together with an initial short-term intravenous application of an antibiotic with only minimal activity against anaerobic intestinal flora. These patients were compared to 48 patients in the previous 12-month period who had only interventional antibiotic therapy in case of established infections. This selective decontamination of the digestive tract (SDD) reduced the colonisation of the respiratory tract, thus also decreasing incidence of nosocomial pneumonia. There were fewer urinary tract infections, while the incidence of wound infections and septicaemia was influenced to microorganism a lesser degree. The number of gram-negative isolated microorganism was reduced, leading to a shift towards gram-positive organisms, especially S. epidermidis. During the 12-month study period there was no change of antibiotic sensitivity of the isolated microorganisms. Although we encountered no problems associated with multiresistant pathogens, routine microbiological surveillance is strongly recommended to detect changes in antibiotic resistance at an early stage.

Administration, Topical↗
PubMedDate not supplied

[Effectiveness of topical selective decontamination, without systemic antibiotic prophylaxis, in prevention of pulmonary infection in intensive care].

Forty-seven patients admitted in our general ICU and treated with Selective Digestive Decontamination (SDD) without any systemic antibiotic prophylaxis, were prospectively studied and compared with an historical group of 50 non treated subjects. The 2 groups were no different as to underlying disease, age, sex and prognostic index (SAPS). In the treated group was recorded an important and statistically significant reduction in the incidence of pneumonia and in the frequency of pulmonary infections caused by enterobacteriaceae and pseudomonceae. Gram-positive identification in tracheal aspirates was not significantly different in the two groups as well as the incidence of "early pneumonia". In the treated group, a sharp decrease of the total amount of fever-days through ICU stay was observed. The antibiotic consumption resulted to be an overall 28.3% lower in the group treated with, SDD with particular regard to broad-spectrum ones.

Anti-Bacterial Agents↗
PubMed1990

Infection control in patients undergoing mechanical ventilation: traditional approach versus a new development--selective decontamination of the digestive tract.

Nosocomial infections are major causes of morbidity and mortality in critically ill patients. Traditional infection control practices focus on preventing infection by controlling patient exposure to microorganisms within the patient's environment. We discuss these practices, along with the factors and organisms responsible for nosocomial infection in the patient undergoing mechanical ventilation. Despite traditional infection control measures, nosocomial infection continues to be a major problem. In recent years evidence has accumulated that points to bacterial colonization of the oropharynx and gastrointestinal tract as a major source of infection. A new technique, selective decontamination of the digestive tract, is being studied extensively for its ability to control colonization of the oral cavity and the gastrointestinal tract. In the technique nonabsorbable topical antibiotics are applied to the oropharynx and instilled into the stomach, and a short course of an intravenous cephalosporin is included. The technique appears a worthwhile addition to traditional infection control measures.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Control of infection in the odontostomatologic field. Possibility of decontamination of critical surfaces].

After a brief description of the sources and procedures of transmission of infections in the odontostomatological field, the Authors illustrate the degree of contamination of a range of surfaces presented by odontological instruments. This is followed by a description of the possibility of a disinfecting treatment using two products one based on iodoform and the other on quaternary ammonium. Prior to this disinfection treatment, the surfaces examined presented a level of microbial contamination (according to the Griffiths scale) for the most part defined as "acceptable with certain reservations" or as "unacceptable", with the almost constant finding of Staphylococci (S. Haemolyticus, aureus, hominis and cohnii) and very frequently of Acinetobacter calcoaceticus, as well as various types of Pseudomonas (Ps. cepacea, maltophilia, and aeruginosa). The disinfection treatment carried out on these same surfaces had a positive effect, leading to a reduction in microbial findings of at least 98% both using energetic disinfectants based on iodoform products, and also milder disinfectants based on quaternary ammonium. Accordingly since both substances used almost constantly reduced the microbial presence despite the different disinfecting action involved, the Authors conclude that not only the use of specific substances but even the mere action of mechanical cleaning may play a fundamental role in the decontamination of surfaces.

Bacteria↗
PubMed1989

Changes of immunological parameters in immunocompromised patients under selective decontamination of the digestive tract. Third Part: Behaviour of some plasma proteins.

We studied the importance of changes in plasma protein concentrations in patients with hematologic systemic diseases treated by selective decontamination of the digestive tract. The concentrations of albumin, acute-phase proteins, immunoglobulins and fibronectin were determined by laser nephelometry in 125 serum samples of eight patients. Results obtained allow the following conclusions: 1. There was a correlation between the clinical condition and concentrations of acid alpha-1-glycoprotein, IgG, CRP and fibronectin. These concentrations might be important for assessment of the course of the disease, effectiveness of therapy and the detection of pathogenetic relations. 2. The acid alpha-1-glycoprotein is of particular importance since relations exist between changes in its concentration and therapeutic results as well as the prognosis of the disease.

Acute-Phase Proteins↗
PubMed1989

[Therapeutic study of the effect of selective decontamination on microbial overgrowth syndrome of the small intestine].

The microbial overgrowth syndrome of the small bowel (MOS) is characterized by clinically found symptoms of increased metabolic activities of microorganisms existing in a great number in the intestinal juice of these patients. We treated 15 patients who suffered from MOS following a modified scheme of selective intestinal decontamination (SID) with oral doses of BerlocombinR (trimethoprim/sulfamerazin) and polymyxin for three weeks. Comparative investigations of duodenal juices before and after treatment showed unchanged high germ-counts (total aerobes and total anaerobes up to 10(7) germs/ml juice). Only the increase of Clostridium (up to 10(6)/ml) was statistically significant which has to be disapproved. In most of the patients there was no subjective improvement. SID in the examined manner is not able to cure a microbial overgrowth in the upper gastrointestinal tract or to reduce facultatively pathogenic microorganisms.

Adult↗
PubMed1989

Selective decontamination of the digestive tract in hematological patients (Czechoslovakia-German Democratic Republic cooperative study.

A group of 55 hematological patients treated for the last 2.5 years by the method of selective decontamination was evaluated. Though both institutes (Bad Saarow, Hradec Králové) worked on the problem in the same conditions (indications for the treatment, characteristics of patients, basic drugs), many differences in details were found. However, the important clinical results were the same: A statistically significant decrease in infections and duration of fever in treated patients. A survey of therapy complications, surveillance of infections and incidence of microbes are presented. The evaluation showed that future research including microbiological and immunological investigation based on a standard protocol will be useful.

Adult↗
PubMed1989

[Mechanical irrigation and selective decontamination in critically ill patients].

The authors debugged and launched into routine operation an automated monitoring system using computer techniques. Working off-line, they monitored microbiological, immunologic and biochemical parameters of mechanical irrigation of the mouth and selective decontamination of the gastro-intestinal tract. They ran and classified the data concerned into two index-sequence subsets defined on a set of patients treated with artificial pulmonary ventilation and patients with reduced defenses, and/or corticoid-dependent patients with myasthenia gravis. At present, they study basic sets, representative enough to permit the statistically significant examination of all the parameters under study as well as their exact interpretation with regard to the efficiency of the therapeutical strategy chosen.

Anti-Infective Agents↗
PubMed1989

Prevention of infectious complications in immunocompromised patients. Part II: Selective decontamination.

The method of selective decontamination of the gastrointestinal tract represents a new possibility of protection of immunocompromised patients against infectious complications with frequent lethal issue. The method is based on employment of such antibiotics and chemotherapeutical drugs that eliminate the aerobic gram-negative microflora and yeasts preserving the anaerobic portion of the bowel microflora that is responsible for the so-called colonization resistance of the intestinal tract. Such a treatment provides patients with more resistance against infection and there is no need for strict reverse isolation. The theoretical exposition of the SD mechanism is given along with instruction on how to use this method and summarizing the hitherto clinical results of its employment. The authors' proper more than 6 year experience is compared with the world literature, and the SD method is stated to be a valuable import in preventing infections in hematological patients. Some unresolved problems and future prospects are also discussed.

Animals↗
PubMed1986

[Decontamination of drinking water taps colonized with Pseudomonas aeruginosa].

Water taps in hospitals are quite often contaminated with Pseudomonas aeruginosa. It is possible that Pseudomonas aeruginosa is disseminated with the water. It seems necessary to disinfect the water taps in order to prevent an endangering of the patients and a contamination of wetted areas. It has been looked for a method of decontamination which could be used under practical conditions. The experimentally contaminated taps could be disinfected in a short time when hot water was lead into the taps. The taps could not be disinfected by heating with a flexible electric heating ribbon.

Disinfection↗
PubMed1988

Decontamination and disposal of nitrosoureas and related N-nitroso compounds.

An improved procedure for chemically decontaminating residues of nitrosoureas and related N-nitroso compounds ("nitrosamides") commonly used in the cancer research laboratory is proposed. Treatment of accumulated wastes with aluminum:nickel alloy powder while progressively increasing the basicity of the medium consistently led to at least 99.98% destruction of each nitrosamide tested. Hazardous diazoalkanes were never detected in yields of greater than 0.1%. The mutagenicity of the completed reaction mixtures was never more than 3 times background except when the N-nitroso compound contained a 2-chloroethyl group. In most cases, the completeness of reaction could be determined chromatographically, not only to demonstrate the disappearance of the starting N-nitroso compound, but also to follow production of identifiable products in sufficient abundance to account for the starting material destroyed; none of the organic products observed was mutagenic in any of the four tester strains used. The procedure described herein proved reliable in two checker laboratories besides our own when applied to mixtures of seven N-nitroso compounds: N-methyl-N-nitroso-p-toluene-sulfonamide; N-methyl-N-nitrosourethane; N-methyl-N-nitrosourea; N-methyl-N'-nitro-N-nitrosoguanidine; N-ethyl-N-nitrosourea; N-ethyl-N'-nitro-N-nitrosoguanidine; and N-ethyl-N-nitrosourethane. All of the other procedures investigated for destruction of nitrosamides, including the widely used approach of dissolving the nitrosamides in alkali, were associated with important disadvantages.

Chemical Phenomena↗
PubMed1986

Fungal infections in acute leukemia patients during selective decontamination of the digestive tract--a clinical, laboratory and pathological study.

Selective decontamination (SD) is used for prevention of bacterial as well as fungal infection in acute leukemia patients during remission induction therapy. We analyzed 138 treatment periods of 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 X 10(9) l for over 25.2 days. In 19 patients there was a suspect of major fungal infection, for which they were given antimycotics (in 15 cases amphotericin B and 5-fluocytosin). Fourteen of them died. Major fungal infections were documented in 5 cases. In 18% of the deceased we found major fungal infection (7 cases of Candida sp., 5 cases of Aspergillus, one case of Candida as well as mucor). There was a correlation between fungal infection, the late stages of the haematological malignancy and the lesions appearing on the oropharyngeal mucosa. However, no correlation appeared to exist in the serological and culture findings between the groups with and without fungal infection. The SD-regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract. The clinical occurrence of major fungal infections published in the E.O.R.T.C.--Gnotobiotic Project Group was 8.2%. According to the literature there is in the eighties a tendency for an increased incidence of aspergillosis. The use of the SD-regime as prophylaxis as well as early antifungal therapy appear to be of great advantage in reducing the frequency of fungal infections in immunocompromised patients.

Acute Disease↗
PubMed1985

Problems and results of selective decontamination in leukemia patients.

Infectious complications play a major part during the cytostatic treatment of patients suffering from acute leukemia, as well as in bone marrow transplantations. For infection prevention, the method of selective decontamination (SD) of the digestive tract was used. This procedure eliminates the potentially pathogenic aerobic bacteria and yeasts while leaving the anaerobic intestinal microflora unaffected. The protocol of the Gnotobiotic Project Group was used in treating 33 patients with SD and the results were compared with those from a comparable control group consisting of cases selected from files who had been treated without SD in the past. A statistical difference was obtained in favor of the SD patients regarding frequency and severity of infection, time between admission and the first signs of infection, days febrile, and in the additional necessity of antibiotics (p less than 0.01). SD involves in addition to a scheduled intake of tablets, microbiological surveillance, personal hygiene and an intact hemostasis, and optimal results can be obtained given the help of the patients' compliance. SD has won a secured place in treatment tailored upon the pathophysiological concept of infection prevention, even though there are problems remaining, e.g., gram-positive cocci, yeasts and infection of the oropharynx.

Acute Disease↗
PubMed1979

Herbicide contamination and decontamination of well waters in Ontario, Canada, 1969-78.

OVER THE 10-YEAR period 1969-78, the waters of 237 wells were analyzed because of contamination from herbicide spillage in or near the well, complaints of impaired water flavor, or injury to seedling plants moistened with the well water. Herbicides were identified in 159 wells: 98 had a single herbicide, 46 had two, 12 had three, one had four, and another had five separate herbicides contributing to the contamination. Wells were grouped according to the mode of entry of the contaminant. Entry occurred most commonly as an aerial spray fdrift or in runoff. Serious contaminations were caused by spillage of herbicide concentrates and spray solutions in or around the well. Twenty-four of the contaminated wells were further investigated to determine the persistence of the contaminant and how to remove it. Some wells were decontaminated adequately to allow reuse within nine weeks, others required three years, and yet others had to be abandoned. Particularly persistent contaminants were amitrole, dinoseb, and picloram.

Herbicides↗
PubMed1984

The clinical significance of gastrointestinal decontamination in the occurrence of endogenous infections.

No significant difference was seen in the incidence of infections between subjects receiving complete, selective and no decontamination aimed at the intestinal microflora in studies evaluating the preventative potential against endogenous infections in the compromised host maintained under protective isolation. This finding is reported together with a report of Serratia marcescens septicemia in a patient with leukemia who was given antibiotics systemically and kept under protective isolation. The establishment of opportunistic infections in relation to these results is discussed in terms of the biological phenomena of the interaction between the intestinal flora and the host, and between the species comprising the intestinal flora.

Adult↗
PubMed1983

[A system for decontamination of liquid radioactive waste produced in in vitro tests in nuclear medicine].

It is well known that very large storage tanks for radioactive liquids are necessary for the disposal of liquid radioactive waste. In vitro tests in radioimmunoassay in nuclear medicine are rapidly increasing for clinical examination causing marked increase in the volume of liquid radioactive waste. Thus we have developed a system for decontaminating radioactivity from liquid waste. In the first step, the liquid waste is boiled by a sterilizer and, in the second step, this sterilised liquid is filtered by a cylindrical filter (Toyo filter No. 84). After filtration, the liquid waste is passed into a beaded charcoal column and an ion exchange resin (Amberlite IRA 402) column. After these treatments, the radioactivity level of liquid waste is lowered to less than 1% of the original radioactivity. We are now in the planning stages of building an apparatus for practical use.

Filtration↗
PubMed1983

The microwave oven: a novel means of decontaminating parasitological specimens and glassware.

This study was conducted to determine the effects of microwave radiation on developmental and infective stages of Eimeria nieschulzi, Strongyloides ratti, and Taenia taeniaeformis. Fecal samples and laboratory preparations containing these three parasites were subjected to microwave radiation for brief periods in a microwave oven, and then in vitro and/or in vivo assessments of viability were made for each organism and preparation. Our results showed that microwave irradiation is extremely effective in killing or preventing development of helminth and protozoan parasites without unduly distorting eggs or developmental stages. Therefore, microwaves may prove useful for decontaminating diagnostic samples or sterilizing contaminated materials in the laboratory and thus for reducing risk to laboratory personnel from parasites of public health importance.

Animals↗