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Alteration of Normal Gastric Flora in Critical Care Patients Receiving Antacid and Cimetidine Therapy

Published online by Cambridge University Press:  02 January 2015

Leigh G. Donowitz ,
M. Carol Page ,
Betty Lou Mileur  and
Sharon H. Guenthner
Leigh G. Donowitz*
Affiliation:
University of Virginia School of Medicine, Charlottesville, Virginia
M. Carol Page
Affiliation:
University of Virginia School of Medicine, Charlottesville, Virginia
Betty Lou Mileur
Affiliation:
University of Virginia School of Medicine, Charlottesville, Virginia
Sharon H. Guenthner
Affiliation:
University of Virginia School of Medicine, Charlottesville, Virginia
*
Department of Pediatrics, Box 386, University of Virginia, School of Medicine, Charlottesville, VA 22908
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Abstract

One hundred fifty-three critical care patients with documented cimetidine and antacid use were prospectively studied with serial gastric pH determinations and semiquantitative gastric fluid cultures. This study documents the abnormal gastric colonization of patients with therapeutically altered gastric acidity by hospital acquired gram negative rods (GNR). Three hundred twenty-four gastric fluid cultures from 153 patients revealed 152 (47%) positive cultures for GNR, 78 (24%) sterile specimens, and 94 (29%) positive for mixed oropharyngeal flora. One hundred forty (59%) of the 236 cultures at a pH of 4 or greater were positive for GNR. In contrast, only 12 (14%) of the 88 cultures at a pH of less than 4 were positive for GNR (p<.001). Forty-six (52%) of 88 cultures at a pH of less than 4 were sterile as compared to only 32 (14%) of 236 sterile cultures at a pH of 4 or greater (p<.001). At low pH, cultures are predominately sterile and at a pH of 4 or greater the flora dramatically changes to hospital acquired GNR. This artificially maintained reservoir of gram negative rods in the critically ill patient is a potential reservoir of organisms causing nosocomial bacteremia or pneumonia in this high risk population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 7 , Issue 1 , January 1986 , pp. 23 - 26
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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References

1.Hoare, AM, Bradby, GVH, Hawkins, CF: Cimetidine in bleeding peptic ulcers. Lancet 1979; 2:671–673.Google Scholar
2.Okabe, S, Takeuchi, K, Urushidani, T: Effects of Cimetidine, a histamine H2-receptor antagonist, on various experimental gastric and duodenal ulcers. American Journal of Digestive Diseases 1977; 22:677–684.Google Scholar
3.Pickard, RG, Sanderson, I, South, M: Controlled trial of Cimetidine in acute upper gastrointestinal bleeding. Br Med J 1979; 1:661–662.CrossRefGoogle ScholarPubMed
4.Bailey, WR, Scott, EG: Diagnostic Microbiology, ed 3. St. Louis, CV Mosby Co, 1970.Google Scholar
5.Edwards, PR, Ewing, WH: Identification of Enterobacteriaceae. Minneapolis, Burgess Publishing Co, 1972.Google Scholar
6.Drasar, 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
7.Gianella, RA, Broitman, SA, Zamcheck, M: Gastric acid barrier to ingested micro-organisms: Studies in vivo and in vitro. Gut 1972; 13:251–256.Google Scholar
8.Cash, RA, Music, SI, Libonati, JP, et al: Response of man to infection with vibrio cholerae I. Clinical, serologic and bacteriologie responses to a known inoculum. J Infect Dis 1974; 129:45–52.Google Scholar
9.Music, SI, Libonati, JP, Wenzel, RP, et al: Induced human cholera. Antimicrob Agents Chemother 1970; 10:462–466.Google ScholarPubMed
10.Donowitz, LG, Marsik, FJ, Fisher, KA, et al: Nosocomial Klebsiella bacteremia in a newborn intensive care unit caused by contaminated breast milk. Rev Infect Dis 1981; 3:716–720.Google Scholar
11.Forster, A, Niethammer, T, Pitteland, J, et al: The effect of Cimetidine on the growth of bacteria in the gastric juice. Crit Care Med 1981; 9:259.Google Scholar
12.DuMoulin, GC, Hedley-Whyte, J, Paterson, DG, et al: Aspiration of gastric bacteria in antacid treated patients: A frequent cause of postoperative colonization of the airway. Lancet 1982; 1(Jan-Mar):242–245.Google Scholar
13.Hillman, KM, Riordan, T, O'Farrell, SM, et al: Colonization of the gastric contents in critically ill patients. Crit Care Med 1982; 10:444–447.CrossRefGoogle ScholarPubMed
14.Keighley, MRB, Finegold, SM: Microflora and postoperative infection in gastroesophageal surgery. Infections in Surgery 1983; 2(8):564–570.Google Scholar
15.Snepar, R, Poporad, GA, Romano, JM, et al: Effect of Cimetidine and antacid on gastric microbial flora. Infect Immun 1982; 36(2):518–524.Google Scholar
16.Ruddell, WSJ, Axon, ATR: Effect of Cimetidine on the gastric bacterial flora. Lancet 1980; 1:672–674.CrossRefGoogle ScholarPubMed
17.Muscroft, TJ, Youngs, D, Burdon, DW, et al: Cimetidine and the potential risk of postoperative sepsis. Br J Surg 1981; 68:557–559.Google Scholar