Selective digestive tract decontamination and vancomycin-resistant Enterococcus isolation in the surgical intensive care unit

Citation
R. Dahms et al., Selective digestive tract decontamination and vancomycin-resistant Enterococcus isolation in the surgical intensive care unit, SHOCK, 14(3), 2000, pp. 343-346
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Cardiovascular & Hematology Research
Journal title
SHOCK
ISSN journal
1073-2322 → ACNP
Volume
14
Issue
3
Year of publication
2000
Pages
343 - 346
Database
ISI
SICI code
1073-2322(200009)14:3<343:SDTDAV>2.0.ZU;2-W
Abstract
Vancomycin-resistant Enterococcus (VRE) has emerged as a significant nosoco mial pathogen in the surgical intensive care unit (SICU). We wished to test the hypothesis that the use of selective digestive tract decontamination ( SDD) in the SICU affects the frequency of VRE isolation. A retrospective re view of hospital records and the SICU database was performed using patients admitted to the SICU service for three or more days from January 1, 1996 t o December 31, 1999 at our large tertiary-care teaching hospital. During th is time use of SDD in selected patient populations decreased due to physici an preference. Information gathered included length of SICU stay, presence of VRE infection or colonization, and use and duration of SDD protocol, van comycin, and ceftazidime. There were 110 newly diagnosed VRE cases in the S ICU during this time period. During the same time period 54 patients receiv ed SDD. Eight patients who received SDD had positive VRE cultures and seven had the initial positive culture after receiving SDD. Overall, 9.1% of eli gible SICU patients received SDD, 18.5% of patients in the SICU for over 3 days had VRE, 7.3% of VRE patients received SDD, and 13.0% of the SICU pati ents who received SDD subsequently developed VRE. SDD use was not associate d with VRE in univariate analysis. Logistic regression analysis showed high er odds ratios for SDD use in combination with vancomycin than for vancomyc in use alone (OR=4.3 vs. 10.9). Odds ratios were over three times higher fo r SDD plus vancomycin plus ceftazidime use when compared to vancomycin plus ceftazidime use alone (OR=70.5 vs. 19.8). We conclude that administration of SDD alone did not correlate with increased VRE isolation, but that SDD u se in conjunction with vancomycin and ceftazidime was associated with VRE i solation.