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Intestinal Decontamination for Control of Nosocomial Multiresistant Gram-Negative Bacilli: Study of an Outbreak in an Intensive Care Unit

Christian Brun-Buisson, MD; Patrick Legrand, MD; Alain Rauss, MD; Claude Richard, MD; Françoise Montravers, MD; Mohamed Besbes, MD; Jonathan L. Meakins, MD; Claude J. Soussy, MD; and François Lemaire, MD
[+] Article, Author, and Disclosure Information

Request for Reprints: Christian Brun-Buisson, MD, Service de Réanimation Médicale, Hôpital Henri Mondor, 94010 Créteil, France.

Current Author Addresses: Drs. Brun-Buisson, Rauss, Montravers, Besbes, and Lemaire: Service de Réanimation Médicale, Hôpital Henri Mondor, Université Paris-XII, 51 avenue de Lattre de Tassigny, 94010 Créteil, France.

Drs. Legrand and Soussy: Service de Microbiologie, Hôpital Henri Mondor, avenue de Lattre de Tassigny, 94010 Créteil, France.

Dr. Richard: Institut Pasteur, 28 rue du Dr Roux, 75724 Paris Cedex 15, France.

Dr. Meakins: Department of Surgery, Royal Victoria Hospital, MacGill University, 687 avenue des Pins Ouest, Montreal, Quebec H3A 1A1 Canada.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(11):873-881. doi:10.7326/0003-4819-110-11-873
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Study Objective: To study the efficacy of intestinal decontamination by oral nonabsorbable antibiotic agents to control a nosocomial outbreak of intestinal colonization and infection with multiresistant Enterobacteriaceae, and to examine its effects on endemic nosocomial infection rates.

Design: A 10-week prospective incidence study (group 1), and then an 8-week randomized, open trial of intestinal decontamination (groups 2 and 3).

Setting: A medical intensive care unit of a tertiary care university hospital.

Patients: Consecutive patients with unit stay of over 2 days and a severity score at admission of more than 2; 124 patients were included in group 1, 50 in group 2 (control), and 36 in group 3 (intestinal decontamination).

Interventions: Neomycin, polymyxin E, and nalidixic acid were given to group 3 patients throughout their stay in the unit.

Measurements and Main Results: Intestinal colonization with multiresistant strains occurred in 19.6% of patients in group 1, at a mean of 16 days after admission, and preceded detection in clinical samples by a mean of 11 days. During the decontamination trial, intestinal colonization rates decreased to 10% (group 2), and 3% (group 3) (P = 0.12 and P < 0.01, compared with group 1, respectively). Corresponding infection rates were 9% (group 1), 3% (group 2), and 0 (group 3). No new cases were detected in the following 4 months. The intestinal colonization rate with gram-positive cocci was higher in group 3 than group 2 (P < 0.001). The overall rate of nosocomial infections was at 28% (group 1), 33% (group 2), and 32% (group 3).

Conclusions: Intestinal decontamination can help to control an outbreak of intestinal colonization and infection with multiresistant gram-negative bacilli in the intensive care unit, but should not be recommended for routine prevention of endemic nosocomial infections.





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