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Stress Ulcer Prophylaxis and Ventilation Pneumonia Prevention by Antibacterial Cytoprotective Agents?

Published online by Cambridge University Press:  07 April 2017

F. Daschner ,
I. Kappstein ,
I. Engels ,
K. Reuschenbach ,
J. Pfisterer ,
N. Krieg  and
W. Vogel
F. Daschner*
Affiliation:
Department of Hospital Epidemiology, University Hospital of Freiburg, Federal Republic of Germany
I. Kappstein
Affiliation:
Department of Hospital Epidemiology, University Hospital of Freiburg, Federal Republic of Germany
I. Engels
Affiliation:
Department of Hospital Epidemiology, University Hospital of Freiburg, Federal Republic of Germany
K. Reuschenbach
Affiliation:
Department of Hospital Epidemiology, University Hospital of Freiburg, Federal Republic of Germany
J. Pfisterer
Affiliation:
Department of Hospital Epidemiology, University Hospital of Freiburg, Federal Republic of Germany
N. Krieg
Affiliation:
Department of Anesthesiology, University Hospital of Freiburg, Federal Republic of Germany
W. Vogel
Affiliation:
Department of Anesthesiology, University Hospital of Freiburg, Federal Republic of Germany
*
Department of Hospital Epidemiology, University Hospital of Freiburg, Hugstetter Str. 55, 7800 Freiburg, FRG
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Abstract

The gastric and tracheal flora of 142 consecutive patients receiving stress ulcer prophylaxis were investigated, identifying identical isolates by typing. Furthermore, the growth pattern of normal respiratory bacteria and organisms causing ventilation pneumonia at different pH values and the in vitro effect of sucralfate and bismuth subsalicylate on these bacteria in simulated gastric fluid were studied. The results obtained were as follows: (1) with rising gastric pH bacterial counts in gastric aspirates, especially gram-negatives, increased significantly; (2) in 45 (31.7%) of the patients identical organisms were first isolated in gastric samples and one to two days later in tracheal secretions; (3) ventilation pneumonia was significantly more frequent in patients with high gastric pH; (4) pathogens causing ventilation pneumonia grew well in simulated gastric fluid at higher pH values, unlike normal respiratory organisms; and (5) sucralfate and bismuth subsalicylate showed antibacterial activity against frequent causative organisms of ventilation pneumonia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 2 , February 1988 , pp. 59 - 65
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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References

1.Dixon, RE: Nosocomial respirator): infections. Infect Control 1983; 4:376–381.CrossRefGoogle ScholarPubMed
2.Bryan, CS, Reynolds, KL: Bacteremic nosocomial pneumonia. Am Rev Respir Dis 1984; 129:668–671.Google Scholar
3.Cross, AS, Roup, B: Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981; 70:681–685.CrossRefGoogle ScholarPubMed
4.Craig, CP, Connelly, S: Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984; 12:233–238.CrossRefGoogle ScholarPubMed
5.Johanson, WG, Pierce, AK, Sanford, JP, et al: Nosocomial respiratory infections with gram-negative bacilli-The significance of colonization of the respirator. Ann Intern Med 1972; 77:701–706.CrossRefGoogle Scholar
6.Sanderson, PJ: Colonization of the trachea in ventilated patients: What is the bacterial pathway? J Hosp Infect 1983; 4: 15–18.CrossRefGoogle ScholarPubMed
7.McCrae, W, Wallace, I': Aspiration around high volume, low pressure endotracheal cuff. Br Med J 1981; 2:1220–1221.Google Scholar
8.Daschner, FD: Useful and useless hygienic techniques in intensive care units. Intensive Care Mud 1985: 11:280–283.Google Scholar
9.Craven, DE, Goularte, TA, Make, BJ: Contaminated condensate in mechanical ventilator circuits. Am Rev Respir Dis 1984: 129:625–628.Google ScholarPubMed
10.Atherton, ST, White, DJ: Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet 1978; i:968–969.Google Scholar
II.Brooks, D: Gastrointestinal bleeding in acute respiratory failure. Br Med J 1978; i:922–923.CrossRefGoogle Scholar
12.du Moulin, GC, Paterson, DG, Hedley-White, J, et al: Aspiration of gastric bacteria in antacid-treated patients: A frequent cause of postoperative colonisation of the airway. Lancet 1982: i:242–245.CrossRefGoogle Scholar
13.Kahn, RJ, Serruys-Schoutens, E, Brimioulle, S, et al: Influence of antacid treatment on the tracheal flora in mechanically ventilated patients. Crit Care Med 1982; 10:229.Google Scholar
14.Draser, BS, Shiner, M, McLeod, GM: Studies on the intestinal flora—I The bacterial flora of the gastrointestinal tract in healthy and achlorhydric persons. Gastroenterology 1969: 56:71–79.Google Scholar
15.Hillman, KM, Riordan, TO'Farrell, SM. et al: Colonization of the gastric contents in critically ill patients. Crit Care Med 1982; 10:444–447.CrossRefGoogle ScholarPubMed
16.Mauritz, W, Graninger, W, Schindlcr, I, et al: Bacterial Mora in gastric juice and bronchial secretion in intensive care patients under long-term respirator treatment. Anaesthesist 1985; 34:203–207.Google Scholar
17.Donowitz, LG, Page, C, Mileur, BL, et al: Alteration of normal gastric flora in critical care patients receiving antacid and c imetidinc therapy. Infect Control 1986; 7:23–26.Google Scholar
18.Ruddell, WS, Axon, ATR: Effect ot cimetidine on the gastric bacterial Mora. Lancet 1980; i:672–674.CrossRefGoogle Scholar
19.Craven, DE, Kunches, LM, Klinsky, V, et al: Risk factors tor pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Resp Dis 1986; 133:792–796.Google Scholar
20.McGonan, JR Jr: Role of the microbiologyolaboratory in prevention and control of nosocomial infections, in Lennette, EH, Balows, A, Hausler, WJ Jr, et al (eds): Manual of Clinical Microbiology ed 4. Washington DC, American Society for Microbiology, 1985, pp 110–122.Google Scholar
21.Fritsche, D, Dostal, CH, Spieckermann, CH: Research into the epidemiologic behavior of Serratia marcescens by means of bacteriocin typing. Zentralbl Bakteriol Mikrobiol Hyg 1 Abt Orig A 1973; 223:513–519.Google Scholar
22.Mathews, DE, Farewell, VT: Using and Understanding Medical Statistics, ed I. Basel-New York, Karger, 198.5, pp 139–147.Google Scholar
23.Wynne, JW, Modell, JH: Respiratory aspiration of stomach contents. Ann Intern Med 1977; 87:466–474.Google Scholar
24.Mehta, S: The risk of aspiration in presence of cuffed endotracheal tubes. Br J Anaesth 1972; 44:601–605.CrossRefGoogle ScholarPubMed
25.Huxley, EJ, Virosiav, J, Grav, WR, et al: Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978: 64:564–567.Google Scholar
26.Spray, SB, Zuidema, GD, Cameron, JL: Aspiration pneumonia—Incidence of aspiration with endotracheal tubes. Am J Surg 1976; 331:701–703.Google Scholar
27.Treloar, DM, Stechmiller, J: Pulmonary aspiration in tube-fed patients with artificial airways. Heart Lung 1984; 13:067–671.Google Scholar
28.Borrero, E, Bank, SPMargolis, I. et al: Comparison of antacid and sueralfate in the prevention of gastrointestinal bleeding in patients who are critically ill. Am J Med 1985; 70(suppl 2C):62–64.CrossRefGoogle Scholar
29.Tryba, M, Zevounou, F, Torok, M, et al: Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. Am J Med 1985; 79(suppl 2C):55–61.Google Scholar
30.Lain, SK, Lee, NW, Koo, J, et al: Randomized crossover trial of tripotassium dicitrato bismuthate versus high close cimetidine for duodenal ulcers resistant to standard doses of cimetidine. Gut 1984; 25:703–706.Google Scholar
3 I.Pounder, RE: Duodenal ulcers that will nut heal. Gut 1984; 25:697–702.Google Scholar
32.Marshall, BJ: Campylobacter pyloridis and gastritis. J Infect Dis 1986; 153:650–657.Google Scholar
33.Stoutenbeek, CP, van Saene, HKF, Miranda, DR, et al: The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 1984; 10:185–192.Google Scholar
34.Unertl, K, Ruckdeschel, G, Selbmann, HK, et al: Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 1987; 13:106–133.Google Scholar