Document Detail


Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units.
MedLine Citation:
PMID:  23203301     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selective decontamination on acquisition of colistin-resistant gram-negative bacteria (GNB) using data from a cluster-randomized study and a single-centre cohort. METHODS: Acquisition of colistin-resistant GNB and conversion from susceptible to resistance in GNB was determined in respiratory samples [from patients receiving SDD (n = 455), SOD (n = 476), or standard care (SC) (n = 315)], and in rectal swabs from 1,840 SDD-patients. Genotyping of converting isolates was performed where possible. RESULTS: The respiratory tract acquisition rates of colistin-resistant GNB were comparable during SDD, SOD, and SC and ranged from 0.7 to 1.1/1,000 patient-days at risk. Rectal acquisition rates during SDD were <3.3/1,000 days at risk. In patients with respiratory tract GNB carriage, conversion rates were 3.6 and 1.1/1,000 patient-days at risk during SDD and SC, respectively, (p > 0.05). In patients with rectal GNB carriage conversion rates during SDD were 5.4 and 3.2/1,000 days at risk and 15.5 and 12.6/1,000 days at risk when colonized with tobramycin-resistant GNB. CONCLUSIONS: Acquisition rates with colistin-resistant GNB in the respiratory tract were low and comparable with and without topical use of colistin. Rates of acquisition of colistin-resistant GNB during SDD were-in ICUs with low endemicity of antibiotic resistance-<2.5/1,000 days at risk, but were fivefold higher during persistent GNB colonization and 15-fold higher during carriage with tobramycin-resistant GNB.
Authors:
Evelien A N Oostdijk; Loek Smits; Anne Marie G A de Smet; Maurine A Leverstein-van Hall; Jozef Kesecioglu; Marc J M Bonten
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-1
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA, Utrecht, The Netherlands, E.A.N.Oostdijk@umcutrecht.nl.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Setup for investigating gold nanoparticle penetration through reconstructed skin and comparison to p...
Next Document:  Biting Performance and Skull Biomechanics of a Chisel Tooth Digging Rodent (Ctenomys tuconax; Caviom...