Changing bacterial ecology during a five year period of selective intestinal decontamination
Changing bacterial ecology during a five year period of selective intestinal decontamination
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DOI：
10.1016/s0195-6701(98)90258-4
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发表时间：
1998-07-01
影响因子：
6.9
通讯作者：
Benzer, H
中科院分区：
文献类型：
--
作者：
Lingnau, W;Berger, J;Benzer, H
选择性消化道去污（SDD）过程中细菌耐药性的发展是有争议的。我们在外科重症监护病房进行了一项随机、安慰剂对照试验，研究了SDD治疗前一年和期间对细菌耐药性的影响。我们将患者随机分为两种不同的局部治疗方案（PTA， PCA）或安慰剂，每天四次对口咽和胃肠道进行治疗。所有患者均静脉注射环丙沙星（200mg / d），连续4天。两种SDD方案都成功地减少了需氧革兰氏阴性肠道定植。肠杆菌科和铜绿假单胞菌的耐药性没有增加。醋酸钙不动杆菌在1年内出现多重耐药，但组间差异不显著。我们发现了革兰氏阳性菌的转变。耐oxacillin金黄色葡萄球菌与环丙沙星耐药同时增加，从17%增加到80.7%，并且SDD患者的耐药频率明显更高(P
The de development of bacterial resistance during selective decontamination of the digestive tract (SDD) is controversial. We studied effects on bacterial resistance one year before and during a randomized, placebo-controlled trial of SDD in a surgical intensive care unit. We randomized patients within two different topical regimens (PTA, PCA) or placebo, administered four-times daily to both the oropharynx and gastrointestinal tract. All patients received intravenous ciprofloxacin (200 mg b.d.) for four days. Both SDD regimens successfully reduced aerobic Gram-negative intestinal colonization. There was no increase in resistance of Enterobacteriaceae or Pseudomonas aeruginosa. Acinetobacter calcoaceticuss developed multi-resitance over one year, but differences between groups were not significant. We detected a shift towards Gram-positive organisms. Oxacillin-resistant Staphylococcus aureus increased in concert with ciprofloxacin resistance, from 17 to 80.7%, and frequencies of resistance were significantly higher in SDD patients (P