Skip to main content

Decolonization in Infection Control of Gram-Negative Bacilli

  • Chapter
  • First Online:
  • 2099 Accesses

Abstract

Colonization of the gastrointestinal tract or skin with Gram-negative bacilli often precedes clinical infection. Decolonization of the gastrointestinal tract and skin may be effective in eradicating these organisms, thereby preventing subsequent clinical infection and healthcare-associated transmission. The goal of this chapter is to review available evidence addressing these practices evaluating both their effectiveness and the potential adverse consequences of these strategies, including the selection of organisms resistant to the decolonizing agent.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Fritz SA, Camins BC, Eisenstein KA, et al. Effectiveness of measures to eradicate staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial. Infect Control Hosp Epidemiol. 2011;32(9):872–80. doi:10.1086/661285.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Giuliano CA, Rybak MJ. Efficacy of triclosan as an antimicrobial hand soap and its potential impact on antimicrobial resistance: a focused review. Pharmacotherapy. 2015;35(3):328–36. doi:10.1002/phar.1553.

    Article  CAS  PubMed  Google Scholar 

  3. Climo MW, Sepkowitz KA, Zuccotti G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med. 2009;37(6):1858–65. doi:10.1097/CCM.0b013e31819ffe6d.

    Article  CAS  PubMed  Google Scholar 

  4. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368(24):2255–65. doi:10.1056/NEJMoa1207290.

    Article  CAS  PubMed  Google Scholar 

  5. Munoz-Price LS, De La Cuesta C, Adams S, et al. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol. 2010;31(10):1074–7. doi:10.1086/656243.

    Article  PubMed  Google Scholar 

  6. Apisarnthanarak A, Pinitchai U, Warachan B, Warren DK, Khawcharoenporn T, Hayden MK. Effectiveness of infection prevention measures featuring advanced source control and environmental cleaning to limit transmission of extremely-drug resistant Acinetobacter baumannii in a Thai intensive care unit: an analysis before and after extensive flooding. Am J Infect Control. 2014;42(2):116–21. doi:10.1016/j.ajic.2013.09.025.

    Article  PubMed  Google Scholar 

  7. Borer A, Gilad J, Porat N, et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect. 2007;67(2):149–55. doi: S0195-6701(07)00259-9 [pii]

    Article  CAS  PubMed  Google Scholar 

  8. Martinez-Resendez MF, Garza-Gonzalez E, Mendoza-Olazaran S, et al. Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. Am J Infect Control. 2014;42(7):713–7. doi:10.1016/j.ajic.2014.03.354.

    Article  CAS  PubMed  Google Scholar 

  9. Lin MY, Lolans K, Blom DW, et al. The effectiveness of routine daily chlorhexidine gluconate bathing in reducing Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae skin burden among long-term acute care hospital patients. Infect Control Hosp Epidemiol. 2014;35(4):440–2. doi:10.1086/675613.

    Article  CAS  PubMed  Google Scholar 

  10. Cassir N, Thomas G, Hraiech S, et al. Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria. Am J Infect Control. 2015;43(6):640–3. doi:10.1016/j.ajic.2015.02.010.

    Article  CAS  PubMed  Google Scholar 

  11. Boonyasiri A, Thaisiam P, Permpikul C, et al. Effectiveness of chlorhexidine wipes for the prevention of multidrug-resistant bacterial colonization and hospital-acquired infections in intensive care unit patients: a randomized trial in Thailand. Infect Control Hosp Epidemiol. 2016;37(3):245–53. doi:10.1017/ice.2015.285.

    Article  PubMed  Google Scholar 

  12. Derde LP, Cooper BS, Goossens H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis. 2014;14(1):31–9. doi:10.1016/S1473-3099(13)70295-0.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mendoza-Olazaran S, Camacho-Ortiz A, Martinez-Resendez MF, Llaca-Diaz JM, Perez-Rodriguez E, Garza-Gonzalez E. Influence of whole-body washing of critically ill patients with chlorhexidine on Acinetobacter baumannii isolates. Am J Infect Control. 2014;42(8):874–8. doi:10.1016/j.ajic.2014.04.009.

    Article  CAS  PubMed  Google Scholar 

  14. Silvestri L, van Saene HK. Selective decontamination of the digestive tract: an update of the evidence. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(1):21–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. de Jonge E, Schultz MJ, Spanjaard L, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet. 2003;362(9389):1011–6. doi: S0140-6736(03)14409-1 [pii]

    Article  PubMed  Google Scholar 

  16. de Smet AM, Kluytmans JA, Blok HE, et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis. 2011;11(5):372–80. doi:10.1016/S1473-3099(11)70035-4.

    Article  PubMed  Google Scholar 

  17. Melsen WG, de Smet AM, Kluytmans JA, Bonten MJ, Dutch SOD-SDD Trialists’ Group. Selective decontamination of the oral and digestive tract in surgical versus non-surgical patients in intensive care in a cluster-randomized trial. Br J Surg. 2012;99(2):232–7. doi:10.1002/bjs.7703.

    Article  CAS  PubMed  Google Scholar 

  18. Saidel-Odes L, Polachek H, Peled N, et al. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage. Infect Control Hosp Epidemiol. 2012;33(1):14–9. doi:10.1086/663206.

    Article  PubMed  Google Scholar 

  19. Oostdijk EA, Kesecioglu J, Schultz MJ, et al. Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: a randomized clinical trial. JAMA. 2014;312(14):1429–37. doi:10.1001/jama.2014.7247.

    Article  PubMed  Google Scholar 

  20. Verwaest C, Verhaegen J, Ferdinande P, et al. Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit. Crit Care Med. 1997;25(1):63–71.

    Article  CAS  PubMed  Google Scholar 

  21. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360(1):20–31. doi:10.1056/NEJMoa0800394.

    Article  PubMed  Google Scholar 

  22. Oostdijk EA, de Smet AM, Bonten MJ, Dutch SOD-SDD trialists group. Effects of decontamination of the digestive tract and oropharynx in intensive care unit patients on 1-year survival. Am J Respir Crit Care Med. 2013;188(1):117–20. doi:10.1164/rccm.201209-1733LE.

    Article  PubMed  Google Scholar 

  23. D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ. 1998;316(7140):1275–85.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials. J Hosp Infect. 2007;65(3):187–203. doi: S0195-6701(06)00484-1 [pii]

    Article  CAS  PubMed  Google Scholar 

  25. Silvestri L, van Saene HK, Casarin A, Berlot G, Gullo A. Impact of selective decontamination of the digestive tract on carriage and infection due to gram-negative and gram-positive bacteria: a systematic review of randomised controlled trials. Anaesth Intensive Care. 2008;36(3):324–38.

    CAS  PubMed  Google Scholar 

  26. Silvestri L, van Saene HK, Weir I, Gullo A. Survival benefit of the full selective digestive decontamination regimen. J Crit Care. 2009;24(3):474.e7–14. doi:10.1016/j.jcrc.2008.11.005.

    Article  Google Scholar 

  27. D’Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E, Liberati A. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000022. doi: 10.1002/14651858.CD000022.pub3.

  28. Agrafiotis M, Siempos II, Falagas ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med. 2010;104(3):325–36. doi: S0954-6111(09)00286-8 [pii]

    Article  PubMed  Google Scholar 

  29. Petros A, Silvestri L, Booth R, Taylor N, van Saene H. Selective decontamination of the digestive tract in critically ill children: systematic review and meta-analysis. Pediatr Crit Care Med. 2013;14(1):89–97. doi:10.1097/PCC.0b013e3182417871.

    Article  PubMed  Google Scholar 

  30. Safdar N, Said A, Lucey MR. The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: a systematic review and meta-analysis. Liver Transpl. 2004;10(7):817–27. doi:10.1002/lt.20108.

    Article  PubMed  Google Scholar 

  31. Lubbert C, Faucheux S, Becker-Rux D, et al. Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience. Int J Antimicrob Agents. 2013;42(6):565–70. doi:10.1016/j.ijantimicag.2013.08.008.

    Article  PubMed  Google Scholar 

  32. Nitschke M, Sayk F, Hartel C, et al. Association between azithromycin therapy and duration of bacterial shedding among patients with Shiga toxin-producing enteroaggregative Escherichia coli O104:H4. JAMA. 2012;307(10):1046–52. doi:10.1001/jama.2012.264.

    Article  CAS  PubMed  Google Scholar 

  33. Paterson DL, Singh N, Rihs JD, Squier C, Rihs BL, Muder RR. Control of an outbreak of infection due to extended-spectrum beta-lactamase – producing Escherichia coli in a liver transplantation unit. Clin Infect Dis. 2001;33(1):126–8. doi: CID000995 [pii]

    Article  CAS  PubMed  Google Scholar 

  34. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent clostridium difficile. N Engl J Med. 2013;368(5):407–15. doi:10.1056/NEJMoa1205037.

    Article  PubMed  Google Scholar 

  35. Lagier JC, Million M, Fournier PE, Brouqui P, Raoult D. Faecal microbiota transplantation for stool decolonization of OXA-48 carbapenemase-producing Klebsiella pneumoniae. J Hosp Infect. 2015;90(2):173–4. doi:10.1016/j.jhin.2015.02.013.

    Article  CAS  PubMed  Google Scholar 

  36. Singh R, van Nood E, Nieuwdorp M, et al. Donor feces infusion for eradication of extended spectrum beta-lactamase producing Escherichia coli in a patient with end stage renal disease. Clin Microbiol Infect. 2014;20(11):O977–8. doi:10.1111/1469-0691.12683.

    Article  PubMed  Google Scholar 

  37. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD003048. doi: 10.1002/14651858.CD003048.pub3.

  38. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307(18):1959–69. doi:10.1001/jama.2012.3507.

    Article  CAS  PubMed  Google Scholar 

  39. Pillai A, Nelson RL. Probiotics for treatment of Clostridium difficile-associated colitis in adults. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004611. doi: 10.1002/14651858.CD004611.pub2.

  40. Shim YH, Lee SJ, Lee JW. Antimicrobial activities of lactobacillus strains against uropathogens. Pediatr Int. 2016; doi:10.1111/ped.12949.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Banach .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Thomas, D., Banach, D. (2018). Decolonization in Infection Control of Gram-Negative Bacilli. In: Bearman, G., Munoz-Price, S., Morgan, D., Murthy, R. (eds) Infection Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-60980-5_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60980-5_24

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60978-2

  • Online ISBN: 978-3-319-60980-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics