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Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection

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Abstract

Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections. These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections. We randomised prospectively 114 patients into a test group receiving SD-medication (n=56) and a control group receiving conventional prophylaxis. Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated. The preoperative administration of SD-medication resulted in adequate decontamination within 3–4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively. Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications. This indicates that prolonged use in these patients might be beneficial. This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Dijkzigt, Erasmus University, Dr. Molewaterplein 40, NL-3015 GD, Rotterdam, The Netherlands

    G. W. M. Tetteroo, C. Ince & H. A. Bruining M. D., Ph. D.

  2. Clinical Microbiology, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands

    J. H. T. Wagenvoort

Authors
  1. G. W. M. Tetteroo
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  2. J. H. T. Wagenvoort
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  3. C. Ince
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  4. H. A. Bruining M. D., Ph. D.
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Tetteroo, G.W.M., Wagenvoort, J.H.T., Ince, C. et al. Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection. Intensive Care Med 16 (Suppl 3), S224–S228 (1990). https://doi.org/10.1007/BF01709705

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