REPLY
Selective Decontamination of the Digestive Tract
Frank R. Cockerill III;
Sharon R. Muller; and
Rodney L. Thompson
15 May 1993 | Volume 118 Issue 10 | Pages 825-826
IN RESPONSE:
We agree that cefotaxime is a systemic antimicrobial that, when administered parenterally, can "selectively" decontaminate the digestive tract of a large variety of aerobic and facultatively anaerobic organisms with little effect on strict anaerobes [1-4]. Theoretically, cefotaxime may both treat and prevent nosocomial infections in patients until their digestive tracts can be adequately decontaminated of potentially pathogenic microorganisms using the oral nonabsorbable antimicrobics.
It is interesting to note that one recent study of antimicrobial prophylaxis in the intensive care setting that did not use a systemic antimicrobial at the beginning of oral decontamination did not show statistically significant reductions in nosocomial infection [5]. We attempted to limit the provision of cefotaxime prophylaxis to approximately 72 hours, the time required in our experience to decontaminate the digestive tract of potential pathogenic microorganisms as assessed by surveillance cultures. In our study, 2 of 12 (17%) and 6 of 36 (17%) infections occurred in the first 72 hours in cefotaxime-treated and non-cefotaxime-treated patients, respectively.
We agree with Dr. Johnson that our study does not distinguish which agent or agents were responsible for the infection reduction and that controlled, blinded, prospective studies are needed.
1. Burdon DW, Ambrose NS, Keighley MR, Youngs D. The effect of a single intravenous dose of cefotaxime on the faecal flora. Infection. 1985; 13:134-6.
2. Michea-Hamzehpour M, Auckenthaler R, Kunz J, Pechere JC. Effect of a single dose of cefotaxime or ceftriaxone on human fecal flora. A double blind study. Drugs. 1988; 35(Suppl 2):6-11.
3. Lambert-Zechovsky N, Bingen E, Aujard Y, Mathieu H. Impact of cefotaxime on the fecal flora in children. Infection. 1985; 13:134-6.
4. Knothe H, Dette GA, Shah PM. Impact of injectable cephalosporins on the gastrointestinal microflora: observations in healthy volunteers and hospitalized patients. Infection. 1985; 13:129-33.
5. Brun-Buisson, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, et al. Intestinal decontamination for control of nosocomial multiresistant gram negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med. 1989; 110:873-81.
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