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PubMed2003

The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis. A randomized trial.

BACKGROUND: Peripheral vasodilatation is central to the pathogenesis of the accompanying hyperkinetic circulatory state and portal hypertension in cirrhotic patients. Selective intestinal decontamination with norfloxacin has been demonstrated to partially correct nitric oxide production in the forearm vasculature of cirrhotic patients. OBJECTIVE: To examine the effects of selective intestinal decontamination on regional and systemic hemodynamics in cirrhotic patients. DESIGN: Randomized, double-blind, placebo-controlled, crossover study. SETTING: Alfred Hospital, Melbourne, Australia. PATIENTS: 14 patients with alcohol-related cirrhosis and 14 matched healthy controls. INTERVENTION: Norfloxacin, 400 mg twice daily, for 4 weeks. MEASUREMENTS: Venous occlusion plethysmography was used to determine forearm blood flow. Cardiac output and the hepatic venous pressure gradient were determined after cardiac catheterization. Glomerular filtration rate was assessed by measuring inulin clearance. Serum levels of endotoxin were determined by chromogenic Limulus amebocytelysate assay. RESULTS: Norfloxacin significantly diminished serum endotoxin levels (average change, -2.14 EU/mL [95% CI, -3.6 to -0.68 EU/mL]). Derived systemic vascular resistance increased significantly with norfloxacin (2.94 units [CI, 0.74 to 5.11 units]) and was accompanied by an increase in mean arterial pressure (8.70 mm Hg [CI, 2.65 to 14.73]), a trend toward decreased cardiac output (-1.207 L/min [range, 0.05 to -2.37 L/min]), a decrease in forearm blood flow (-0.99 mL/100 mL per min [CI, -1.80 to -0.17 mL/100 mL per min]), and a trend toward reduced hepatic venous pressure gradient (-2.43 mm Hg [CI, -5.2 to 0.34 mm Hg]). Norfloxacin did not significantly alter glomerular filtration rate. CONCLUSION: Selective intestinal decontamination with norfloxacin partially reverses the hyperdynamic circulatory state in cirrhotic patients without harming splanchnic or renal hemodynamics.

Anti-Infective Agents↗

PubMed2000

[Selective intestinal bacterial decontamination in experimental acute pancreatitis].

BACKGROUND: Bacterial translocation implies the transit of viable gastric microflora from the intestinal lumen through the intestinal wall to the mesenteric ganglia and seems to be the mechanism by which microflora reach necrotic tissue in acute pancreatitis (AP). This occurs in 40-70% of necrotizing hemorrhagic AP and plays a major role in up to 80% of deaths from this cause. AIMS: To analyze the possible influence of bacterial decontamination in the gut on bacterial translocation in severe experimental AP. METHODS: Severe AP was induced in 43 male Sprague-Dawley rats by administration of 0.2 ml of 2.5% taurodeoxycholate sodium in NaOH glycyl-glycine buffer after cannulizing the bilio-pancreatic duct through the duodenum and clamping the common bile duct in the hepatic junction. The rats were divided into two groups: a) control group: 24 rats in which only AP was induced; b) problem group: 19 rats that underwent bacterial decontamination through the administration of 4 mg/ml gentamicin, bacitracin and neomycin in the drinking water during the 5 days prior to AP induction. Twenty-four hours after AP induction, laparotomy was performed and a sample for the culture of mesenteric lymphatic ganglia, pancreas, liver, spleen, peritoneum and cecum was obtained. RESULTS: Seven rats in the control group died. Of the 17 rats that survived 24 hours, positive cultures in the pancreas were obtained in nine. In the problem group, two rats died within 24 hours. Of the remaining 17 rats, positive pancreatic cultures were obtained in 2 while in 15 pancreatic cultures were negative. No microflora were cultured in the peritoneum. The microflora most frequently cultivated were Escherichia coli, enterococcus and proteus. No differences were found in the percentage of Gram-positive and Gram-negative bacteria between the two groups. CONCLUSIONS: a) The majority of the bacteria in AP tissue originate in the intestinal microflora, E. coli being the most prevalent. b) One of the main mechanisms in this process is bacterial translocation via the lymphatic pathway; transit directly through the transperitoneal pathway is not essential. c) Bacterial translocation already occurs in the earlier phases of AP. d) Bacterial decontamination prior to AP decreases the frequency of bacterial translocation and does not interfere in the Gram-positive/Gram negative balance, nor does it increase fungal infections.

Acute Disease↗

PubMed2002

An alternative simple method in laryngoscope blade decontamination.

The cleaning and disinfection of laryngoscope blades is controversial. The aim of this study is to investigate the efficacy of two different chemical disinfectant agents and tap water where the laryngoscope blades were contaminated by different microorganisms and try to create a simple, effective and easy decontamination method. The results of our study demonstrate that the decontamination of the laryngoscope blades, which are cleansed with tap water, is not a reliable approach. In conclusion, mechanical cleaning of blades with water and the immersion in 2% glutaraldehyde or 10% polyvinyl pyrrolidine iodine for 10 minutes is an effective method for decontamination of laryngoscope blades.

Disinfectants↗

PubMed2002

Different options for metal recovery after sludge decontamination at the Montreal Urban Community wastewater treatment plant.

The MUG (Montreal Urban Community) treatment plant produces approximately 270 tons of dry sludge daily (270 tds/day) during the physico-chemical treatment of wastewater. Recently, this treatment plant endowed a system of drying and granulation of sludge for valorization as an agricultural fertilizer having a capacity of 70 tds/day (25% of the daily sludge production). However, the metal content (mainly Cu and Cd) of the sludge surpasses the norms for biosolids valorization. In order to solve this problem, a demonstration project, from the lab scale to the industrial pilot plant, was carried out to test the Metix-AC technology for the removal of metals. A strongly metal-loaded filtrate was generated during the sludge decontamination. Tests concerned the study of the metal recovery by total precipitation and selective precipitation, as well as the use of alternative products for the metal precipitation. Other works consisted to simulate the acid filtrate recirculation from the decontaminated sludge (25% of the total volume) in the untreated sludge (75% of the total volume) intended for the incineration. The total precipitation with hydrated limeappearedeffectivefortherecoveryof metals (87% Cd, 96% Cr, 97% Cu, 98% Fe, 71% Ni, 100% Pb, 98% Zn). However, this option entails the production of an important quantity of metallic residue, which should be disposed of expensively as dangerous material. The selective iron precipitation does not appear to bean interesting option because the iron in solution within the leached sludge was principally present in the form of ferrous iron, which cannot be precipitated at pH lower than five. On the other hand, the use of commercial precipitating agents (TMT-15, CP-33Z, CP-NB and CPX) without pH adjustment of filtrate gave good results for the recovery of Cu and, to a lesser degree for the recovery of Pb. However, the efficiency for the other metals' (Cd, Cr, Fe, Ni and Zn) recovery was weaker (< 25%). Finally, the acid filtrate recirculation containing solubilised metals in untreated sludge destined for incineration appears to be the most interesting option. Metals in solution in the acid filtrate, precipitate or adsorb effectively (97% Cd, 97% Cr, 99% Cu, 82% Ni, 100% Pb and 87% Zn) on the solids of the untreated sludge. Moreover, TCLP tests were done on ashes produced during the incineration of sludge mixed with the acid filtrate produced during sludge decontamination. These tests showed that there were no significant differences, as regards the extractability of metals, between such ashes and those produced during the untreated sludge incineration without addition of filtrate. Therefore, it was predictable that this method can respect the current environmental standards required by the different governmental authorities.

Chemical Precipitation↗

PubMedDate not supplied

[Prevention of bacterial infection using selective intestinal decontamination in patients with cirrhosis admitted to intensive care. Controlled study in 120 patients].

All cirrhotic patients admitted on a medical intensive care unit, were included in a randomized trial of selective intestinal decontamination provided there was no infection on admission. The selective intestinal decontamination consisted of a regimen of 3 oral, nonabsorbable antibiotics for the 74 first patients (Neomycin 1 gr, Colistin 1.500.000 U, Nystatin 1.000.000 U, every 6 hours), then of norfloxacin, 400 mg BID for the following patients. The duration of treatment was at least 5 days. Of the 120 patients, initially randomized to receive or not the treatment, 26 were ultimately excluded, mainly (18 cases) because of infection present but unrecognized at the time of admission. Ninety four patients were thus compared for the efficiency of the treatment, 45 in the treated group and 49 in the not treated group. The results showed a significant reduction of the episodes of septicemia in the treated group (4 versus 12, P = 0.044). This reduction was evident only for septicemia due to gram negative germs. Mortality was unaffected. When the risk factors were studied, bacterial infection was linked to the degree of hepatic failure. We recommend selective intestinal decontamination for cirrhotic patients admitted on intensive care unit, particularly when hepatic function is poor.

Administration, Oral↗

PubMed2006

[Selective bowel decontamination].

Infective complications play major role in mortality of high risk patients demanding intensive care. Selective Bowel Decontamination prevents endogenous infections by reducing the number of potentially pathogen microbes (aerobic bacteria, fungi) in the oropharynx and gastrointestinal tract, saving anaerobic bacteria. It had been used 20 years ago for the first time. Authors survey it's literature ever since. Selective Bowel Decontamination is performed by the mixture of antibiotics and antimycotic drug, administered orally in hydrogel, and suspension form in nasojejunal tube. The number of Gram negative optional aerobic bacteria and fungi decrease significantly in the gut, and the microbial translocation is following this tendency. Foreign authors achieved good results in acute necrotizing pancreatitis, after liver transplant, in polytrauma, in serious burn and in haematological malignancies. According to the literature Selective Bowel Decontamination shows advantages in selected groups of high risk surgical patients. In some studies the administration took few months, but the minimum time was one week. There was no report of increasing MRSA appearance. Regular bacteriological sampling is highly recommended in order to recognize any new antibiotic resistance in time.

Bacteremia↗

PubMed1986

Changes of plasma fibronectin concentration and phagocytic activity in immunosuppressed patients during selective decontamination.

Plasma fibronectin and phagocytic activity play important roles in combating infections. The question is discussed, whether both defense systems are also of importance in immunosuppressed patients. Further, the behaviour of plasma fibronectin determined by laser nephelometry, and phagocytic activity determined by chemiluminescence is demonstrated in patients with leukaemia under the conditions of selective decontamination of the intestinal tract. The following results are shown: Plasma fibronectin concentration decreases 10 to 14 days before onset of the first clinical signs of an infection. Plasma fibronectin level changes appear earlier than that of C-reactive protein (Crp). Therefore, it is suitable as a parameter for assessment of the course of an infection. Decreased plasma fibronectin levels occurring over longer periods have to be regarded as unfavourable prognostic criterion. The phagocytic activity of immunosuppressed patients selectively decontaminated is significantly below that of healthy adults. A clear assignment of phagocytic activity to the clinical picture, the number of granulocytes and plasma fibronectin level is not possible at present. Additional studies are necessary. Both plasma fibronectin level and phagocytic activity do not appear to be influenced by selective decontamination of the intestinal tract.

Anti-Bacterial Agents↗

PubMed1986

[Decontamination of cell cultures by removing mycoplasmas: a comparison of 3 methods].

Three different methods of decontamination of cell cultures from mycoplasma were compared: by macrophages in the presence of antibiotics, by ultraviolet radiation in the presence of 5-bromuridin and Hoechst-33258, by cloning of cells in the presence of antibiotics metacycline and doxicycline. Only the latter method was effective to decontaminate the cell cultures from mycoplasma. Twelve cell lines were decontaminated and tested for the presence of mycoplasma by microbiological method, by staining with the dye Hoechst-33258 and autoradiography. All the cell lines were free of mycoplasma.

Animals↗

PubMed1993

Increasing the wearing time of vinyl urinary drainage bags by decontamination with bleach.

The purpose of this study was to determine the safety of 4 week re-use of vinyl urinary leg and bed bags in the acute rehabilitation setting when decontaminated daily with a dilute bleach (sodium hypochlorite) rinse. Patients requiring urinary bags (n = 54) were randomly assigned to Control (C) and Experimental (E) groups. C's bags were replaced weekly; E's only after four weeks. Both groups received identical daily bag decontamination and weekly urine and bag cultures. No significant differences were found between groups with ANCOVA, controlling for baseline urine cultures, age, number of days catheterized, and use of antibiotics. Thirty different organisms were cultured in urine and bags; when the procedure was done daily, all bag cultures showed only minimal contamination (0-100CFU/mL). Bacterial growth (4.4% of leg bags) > 100CFU/mL was found only when the daily decontamination procedure had been omitted. In fact, 57% of leg bags and 76.5% of bed bags returned with no growth. We conclude that it is safe and cost effective to reuse vinyl urinary leg and bed bags for four weeks.

Adult↗

PubMed1986

Oropharynx decontamination preventing Candida vegetation on voice prostheses.

Candida vegetations found in silicone voice prostheses used in postlaryngectomy voice rehabilitation are associated with prosthesis dysfunction. Selective oropharyngeal decontamination with amphotericin B lozenges resulted in sharp decrease of oropharyngeal Candida concentrations with a subsequent reduction of yeast colonization on voice prostheses and in tracheoesophageal fistula in ten patients. A case report suggests that this selective oropharyngeal decontamination can prolong the device's lifetime.

Administration, Oral↗

PubMed1980

The efficiency of strict reverse isolation and antimicrobial decontamination in remission induction therapy of acute leukemia.

The efficiency of strict reverse isolation and antimicrobial decontamination in remission induction therapy of acute leukemia was studied retrospectively in 47 patients who were treated with a standardized aggressive chemotherapy of daunorubicin and cytosine arabinoside. Twenty-two patients were treated in strict reverse isolation with antimicrobial decontamination and 25 patients in the open ward without any measures against infections. In the patients in isolation the incidence of new infections per patient was 0.77 compared to 1.42 in the control group. The rate of complete remissions was 77% in the patients in isolation vs. 56% in the control patients.

Acute Disease↗

PubMed1990

The incidence of gram-negative bacterial and fungal infections in liver transplant patients treated with selective decontamination.

We have used selective bowel decontamination in 145 consecutive patients undergoing liver transplantation. In these 145 patients undergoing initial transplantation, we have experienced 42 major bacterial infections in 37 patients. Only five patients have experienced a gram-negative infection and only 2 of 26 documented bacteremias were associated with gram-negative organisms. To date, we have experienced only one systemic Candida infection. These results suggest that selective bowel decontamination may play a major role in reducing the previously reported high incidence of gram-negative and Candida sepsis following liver transplantation.

Bacterial Infections↗

PubMedDate not supplied

Gastrointestinal decontamination in the emergency department.

Pediatric poisoning is a problem commonly encountered in the emergency department. After stabilization of airway, breathing, and circulation, one of the goals of treatment is decontamination in order to limit poison absorption and the resulting systemic toxicity. Decontamination modalities include gastric emptying (ipecac and gastric lavage), inhibiting absorption (activated charcoal), and catharsis (sorbital, magnesium citrate, and whole bowel irrigation). Each modality is discussed. Choice of modality by the practitioner must be individualized to each patient's situation.

Adolescent↗

PubMed2002

Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination.

OBJECTIVE: Infections caused by Candida spp. are a major cause of morbidity and mortality in critically ill patients and usually develop from endogenous colonization. We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections. DESIGN AND SETTING: We performed a prospective, randomized, double-blind, placebo-controlled trial among medical and surgical intensive care unit patients at a large university hospital. PATIENTS: All adult patients mechanically ventilated for at least 48 h with an expectation to remain so for at least an additional 72 h, and receiving selective decontamination of the digestive tract. INTERVENTIONS: Patients were randomly assigned fluconazole 100 mg daily (n=103) or placebo (n=101). MEASUREMENTS AND RESULTS: Candida infections occurred less frequently in the fluconazole group (5.8%) than in the placebo group (16%; rate ratio 0.35; Cl(95) 0.11-0.94). Some 90% of candidemia episodes occurred in the placebo group (rate ratio for fluconazole use 0.10; Cl(95) 0.02-0.74). The rate of treatment failure, development of candidal infection, or increased colonization, was 32% in the fluconazole group and 67% in the placebo group (P<0.001). Crude in-hospital mortality was similar in the two groups (39% fluconazole vs. 41% placebo). CONCLUSIONS: Prophylactic use of fluconazole in a selected group of mechanically ventilated patients at high risk for infection reduces the incidence of Candida infections, in particular candidemia.

Aged↗

PubMed2000

Decontamination of winter flounder (Pleuronectes americanus) following chronic exposure to effluent from a pulp and paper mill.

A study was conducted to determine the influence of decontamination on winter flounder living downstream from a pulp and paper mill. The fish and controls were held 8-26 weeks under contaminant-free conditions in aquaria supplied with ambient sea water. Groups of flounder, for comparison, were also sampled near the paper mill at the time of or following autopsy. No differences were apparent in length/organ-weight relationships between depurated and control groups after 26 weeks at 0-6 degrees C, but condition factor, gonadal and hepatosomatic indices, coincident with elevated levels of detoxifying enzymes, differed from field-derived samples. Pathological changes, including hemosiderin deposits in the liver and spleen, decreased, whereas pericholangitis and clear cell foci were apparent in the depurated fish and in the field samples. In two additional groups decontaminated for 8-16 weeks at 6-16 degrees C, there was no evidence of pericholangitis, but hemosiderin deposits persisted and an increase of fibrosis and clear cell foci occurred in contrast to the field group. These results suggest that some tissue repair in the liver transpired primarily during summer while other lesions, such as preneoplastic clear cell foci, which were probably induced prior to depuration, increased, but hemosiderin concentration remained unchanged. The latter observation is consistent with previous studies that suggest that hemosiderin concentration is not seasonally but age influenced.

Animals↗

PubMed2006

The occurrence of antibiotic resistance genes in Taq polymerases and a decontamination method applied to the detection of genetically modified crops.

Different antibiotic resistance (AR) genes, such as Bla, Tet and NPTII, contaminate commercially available Taq polymerases. The specificity of the AR gene PCR can be increased when using a restriction enzyme-based decontamination of polymerase. The elimination of Taq polymerase contamination allows the use of PCR tests to screen seeds (corn) and processed food for the presence of genetically modified organisms (GMO) based on the detection of AR genes. Without a decontamination procedure for AR genes, PCR screening tests should be interpreted with caution.

Crops, Agricultural↗

PubMed1990

Heavy contamination of operating room air by Penicillium species: identification of the source and attempts at decontamination.

Increased rates of nosocomial infection caused by filamentous fungi in immunocompromised patients prompted microbiologic surveillance of the central air handling systems in our hospital. During a 4-year period, Penicillium species were isolated from 47 patients, including two with surgical wound infections caused by Penicillium. Counts of Penicillium in operating room air were much higher (195 colony-forming units [CFU]/m3) than in 95% filtered corridor air (14.6 CFU/m3; p less than 0.01). Ventilation ducts and terminal units lined with fiberglass in the operating room air handling system were heavily contaminated by Penicillium; the fiberglass was also contaminated with Aspergillus species. Corrective measures included filter replacement and decontamination of the ventilation system with aerosolized chlorine solution. Although operating room air remained free of filamentous fungi during the next 7 months, contamination eventually recurred and required repeated decontamination. We believe that certification guidelines are highly desirable for hospital ventilation systems, especially if the system serves immunocompromised patients.

Air Microbiology↗

PubMed2006

The changing indications of gastrointestinal decontamination in poisonings.

Gastrointestinal (GI) decontamination is commonly used in the treatment of the poisoned patient. Although the practice is widely accepted, the science behind the recommendations is limited. This article describes commonly used techniques for GI decontamination and critically reviews the studies evaluating these treatments.

Charcoal↗