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Treatment and Control of Colonization in the Prevention of Nosocomial Infections

Published online by Cambridge University Press:  02 January 2015

John M. Boyce*
Affiliation:
Miriam Hospital and Brown University, Providence, Rhode Island
*
Division of Infectious Diseases, Miriam Hospital, 164 Summit Ave, Providence, RI 02906

Abstract

Patients frequently develop nosocomial infections that are caused by normal flora colonizing the patient at the time of admission, or by exogenous pathogens that are acquired and subsequently colonize the patient after admission to the hospital. To prevent nosocomial infections, a variety of strategies have been used either to prevent colonization from occurring, to eradicate colonizing organisms, or to prevent the progression from colonization to infection. These strategies include implementation of infection control measures designed to prevent acquisition of exogenous pathogens, eradication of exogenous pathogens from patients or personnel who have become colonized, suppression of normal flora, prevention of colonizing flora from entering sterile body sites during invasive procedures, microbial interference therapy, immunization of high-risk patients, and modification of antibiotic utilization practices. Because strategies that require widespread use of antimicrobial agents to suppress or eradicate colonizing organisms tend to promote emergence of multidrug-resistant pathogens, greater emphasis should be given to those strategies that prevent colonization from occurring or employ techniques other than administration of prophylactic antibiotics to eradicate colonization. Restricting inappropriate use of antibiotics should reduce the frequency with which patients become colonized and infected with multidrug-resistant organisms.

Type
Symposium: Nosocomial Colonization
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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References

1. Bisno, AL. Molecular aspects of bacterial colonization. Infect Control Hosp Epidemiol 1995;16:648657.CrossRefGoogle ScholarPubMed
2. Jarvis, WR. The epidemiology of colonization. Infect Control Hosp Epidemiol 1995;17:4752.CrossRefGoogle Scholar
3. Greene, JN. The microbiology of colonization, including techniques of assessing and measuring. Infect Control Hosp Epidemiol 1995;17:114118.CrossRefGoogle Scholar
4. Massanari, RM, Hierholzer, WJ Jr. A crossover comparison of antiseptic soaps on nosocomial infection rates in intensive care units. Am J Infect Control 1984;12:247248.Google Scholar
5. Maki, D, Hecht, J. Antiseptic containing handwashing agents reduce nosocomial infections: a prospective study. In: Program and Abstracts of the 22nd Interscience Conference of Antimicrobial Agents and Chemotherapy, Miami Beach, FL, 10 4-6, 1982; American Society for Microbiology, Washington, DC, 1982. Abstract 188.Google Scholar
6. Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:8893.CrossRefGoogle ScholarPubMed
7. Albert, RK, Condie, F. Hand-washing patterns in medical intensivecare units. N Engl J Med 1981;24:14651466.CrossRefGoogle Scholar
8. Garner, JS, Simmons, BP. CDC guideline for isolation precautions in hospitals. Infect Control 1983;4:245325.Google ScholarPubMed
9. Lynch, P, Jackson, MM, Cummings, J, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243246.CrossRefGoogle ScholarPubMed
10. Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibioticassociated colitis. J Infect Dis 1981;143:4250.CrossRefGoogle ScholarPubMed
11. Mulligan, ME, Rolfe, RD, Finegold, SM, George, WL. Contamination of a hospital environment by Clostridium difficile . Curr Microbiol 1979;3:173175.CrossRefGoogle Scholar
12. Samore, MH, Venkataraman, L, Degirolami, PC, Levin, E, Karchmer, AW. Recovery of Clostridium difficile from medical personnel and patient contacts correlates with environmental contamination. In: Program and Abstracts of the 93rd American Society of Microbiology General Meeting; Atlanta, GA; 05 1993. Abstract L-1:544.Google Scholar
13. Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.CrossRefGoogle ScholarPubMed
14. Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195200.CrossRefGoogle Scholar
15. Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrugresistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiols 1994;32:11481153.CrossRefGoogle ScholarPubMed
16. Boyce, JM, Potter-Bynoe, G, Chenevert, C, Hughes, NL. Contamination of environmental surfaces with methicillinresistant Staphylococcus aureus (MRSA): infection control implications. Presented at the Fourth Annual Meeting of the Society for Hospital Epidemiology of America; New Orleans, LA; 03 1994. Abstract 14.Google Scholar
17. Garner, JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:5380.CrossRefGoogle ScholarPubMed
18. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities. MMWR 1994;43(RR-13):1132.Google Scholar
19. Fraser, VJ, Johnson, K, Primack, J, Jones, M, Medoff, G, Dunagan, WC. Evaluation of rooms with negative pressure ventilation used for respiratory isolation in seven midwestern hospitals. Infect Control Hosp Epidemiol 1993;14:623628.CrossRefGoogle ScholarPubMed
20. Adal, KA, Anglim, AM, Palumbo, L, Titus, MG, Coyner, BJ, Farr, BM. The use of high-efficiency particulate air-filter respirators to protect hospital workers from tuberculosis. N Engl J Med 1994;331:169173.CrossRefGoogle ScholarPubMed
21. Nettleman, MD, Fredrickson, M, Good, NL, Hunter, SA. Tuberculosis control strategies: the cost of particulate respirators. Ann Intern Med 1994;121:3740.CrossRefGoogle ScholarPubMed
22. Flynn, DM, Weinstein, RA, Nathan, C, Gaston, MA, Kabins, SA. Patients' endogenous flora as the source of ‘nosocomial’ Enterobacter in cardiac surgery. J Infect Dis 1987;156:363368.CrossRefGoogle Scholar
23. Winston, DJ, Ho, WG, Champlin, RE, et al. Norfloxacin for prevention of bacterial infections in granulocytopenic patients. Am J Med 1987;82(suppl 6B):4046.CrossRefGoogle ScholarPubMed
24. Karp, JE, Merz, WG, Hendricksen, C, et al. Oral norfloxacin for prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia. Ann Intern Med 1987;106:17.CrossRefGoogle ScholarPubMed
25. Verhoef, J, Rozenberg-Arska, M, Dekker, A. Prevention of infection in the neutropenic patient. Rev Infect Dis 1989;11(suppl 7):15451550.CrossRefGoogle ScholarPubMed
26. Winston, DJ, Ho, WG, Nakao, SL, Gale, RP, Champlin, RE. Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients. Am J Med 1986;80:884890.CrossRefGoogle ScholarPubMed
27. Dekker, AW, Rozenberg-Arska, M, Verhoef, J. Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med 1987;106:712.CrossRefGoogle ScholarPubMed
28. Malik, IA, Abbas, Z, Karim, M. Randomized comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febrile patients. Lancet 1992;339:10921096.CrossRefGoogle ScholarPubMed
29. GIMEMA Infection Program. Prevention of bacterial infection in neutropenic patients with hematologic malignancies. A randomized, multicenter trial comparing norfloxacin with ciprofloxacin. Ann Intern Med 1991;115:7112.CrossRefGoogle Scholar
30. Warren, RE, Wimperis, JZ, Baglin, TP, Constantine, CE, Marcus, R. Prevention of infection by ciprofloxacin in neutropenia. J Antimicrob Chemother 1990;26(suppl F):109123.CrossRefGoogle ScholarPubMed
31. Arning, M, Wolf, HH, Aul, C, Heyll, A, Scharf, RE, Schneider, W. Infection prophylaxis in neutropenic patients with acute leukemia—a randomized, comparative study with ofloxacin, ciprofloxacin and co-trimoxazole/colistin. J Antimicrob Chemother 1990;26(suppl D):137142.CrossRefGoogle Scholar
32. Archimbaud, E, Guyotat, D, Maupas, J, et al. Pefloxaxin and vancomycin vs. gentamicin, colistin sulphate and vancomycin for prevention of infections in granulocytopenic patients: a randomized double-blind study. Eur J Cancer 1991;27:174178.CrossRefGoogle Scholar
33. Attal, M, Schlaifer, D, Rubie, H, et al. Prevention of gram-positive infections after bone marrow transplantation by systemic vancomycin: a prospective, randomized trial. J Clin Oncol 1991;9:865870.CrossRefGoogle ScholarPubMed
34. Lim, SH, Smith, MP, Machin, SJ, Goldstone, AH. A prospective randomized study of prophylactic teicoplanin to prevent early Hickman catheter-related sepsis in patients receiving intensive chemotherapy for haematological malignancies. Eur J Haematol 1993;54:1013.CrossRefGoogle ScholarPubMed
35. Wimperis, JZ, Baglin, TP, Marcus, RE, Warren, RE. An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts. Bone Marrow Transplant 1991;8:363367.Google ScholarPubMed
36. Jeffery, GM, Beard, ME, Ikram, RB, et al. Intranasal amphotericin B reduces the frequency of invasive aspergillosis in neutropenic patients. Am J Med 1991;90:685692.CrossRefGoogle ScholarPubMed
37. Philpott-Howard, JN, Wade, JJ, Mufti, GJ, Brammer, KW, Ehninger, G, Multicentre Study Group. Randomized comparison of oral fluconazole versus oral polyenes for the prevention of fungal infection in patients at risk of neutropenia. J Antimicrob Chemother 1993;31:973984.CrossRefGoogle ScholarPubMed
38. Winston, DJ, Chandrasekar, PH, Lazarus, HM, et al. Fluconazole prophylaxis of fungal infections in patients with acute leukemia. Results of a randomized placebo-controlled, double-blind, multicenter trial. Ann Intern Med 1993;118:495503.CrossRefGoogle ScholarPubMed
39. Denning, DW, Donnelly, JP, Hellreigel, KP, Ito, J, Martino, P, van'tWout, JW. Antifungal prophylaxis during neutropenia or allogeneic bone marrow transplantation: what is the state of the art? Ad Hoc Working Group. Chemotherapy 1992;38(suppl 1):4349.CrossRefGoogle ScholarPubMed
40. Thunnissen, PL, Sizoo, W, Hendriks, WD. Safety and efficacy of itraconazole in prevention of fungal infections in neutropenic patients. Neth J Med 1991;39:8491.Google ScholarPubMed
41. Stoutenbeek, CP, vanSaene, HK, Miranda, DR, Zandstra, DF, Langrehr, D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1987;27:357364.CrossRefGoogle ScholarPubMed
42. Brun-Buisson, C, Legrand, P, Rauss, A, 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;110:873881.CrossRefGoogle Scholar
43. Hartenauer, U, Thulig, B, Diemer, W, et al. Effect of selective flora suppression on colonization, infection, and mortality in critically ill patients: a one-year, prospective consecutive study. Crit Care Med 1991;19:463473.CrossRefGoogle ScholarPubMed
44. Winter, R, Humphreys, H, Pick, A, MacGowan, AP, Willatts, SM, Speller, DCE. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother 1992;30:7387.CrossRefGoogle ScholarPubMed
45. Cockerill, FR, Muller, SR, Anhalt, JP, et al. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 1992;117:545553.CrossRefGoogle ScholarPubMed
46. Flaherty, J, Nathan, C, Kabins, SA, Weinstein, RA. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 1990;162:13931397.CrossRefGoogle Scholar
47. European Society of Intensive Care Medicine, Societe Reanimation de Langue Francaise. The first European consensus conference in intensive care medicine: selective decontamination of the digestive tract in intensive care unit patients. Infect Control Hosp Epidemiol 1992;13:609611.CrossRefGoogle Scholar
48. Zobel, G, Kuttnig, M, Grubbauer, H-M, Semmelrock, H-J, Thiel, W. Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract. Crit Care Med 1991;19:12421246.CrossRefGoogle ScholarPubMed
49. Hammond, JMJ, Saunders, GL, Potgieter, PD, Forder, AA. Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992;340:59.CrossRefGoogle ScholarPubMed
50. Kaufhold, A, Behrendt, W, Krauss, T, vanSaene, H. Selective decontamination of the digestive tract and methicillin-resistant Staphylococcus aureus . Lancet 1992;339:14111412.CrossRefGoogle ScholarPubMed
51. Bonten, MJM, vanTiel, FH, vanderGeest, S, Stobberingh, EE, Gaillard, CA. Enterococcus faecalis pneumonia complicating topical antimicrobial prophylaxis. N Engl J Med 1993;328:209210.CrossRefGoogle ScholarPubMed
52. Webb, CH. Antibiotic resistance associated with selective decontamination of the digestive tract. J Hosp Infect 1992;22:15.CrossRefGoogle ScholarPubMed
53. Daschner, F. Emergence of resistance during selective decontamination of the digestive tract. Eur J Clin Microbiol Infect Dis 1992;11:13.CrossRefGoogle ScholarPubMed
54. Boukadida, J, deMontalembert, M, Gaillard, J-L, et al. Outbreak of gut colonization by Pseudomonas aeruginosa in immunocompromised children undergoing total digestive decontamination: analysis by pulsed-field electrophoresis. J Clin Microbiol 1991;29:20682071.CrossRefGoogle ScholarPubMed
55. McQuillen, DP, Zingman, BS, Meunier, F, Levitz, SM. Invasive infections due to Candida krusei: report of ten cases of fungemia that include three cases of endophthalmitis. Clin Infect Dis 1992;14:472478.CrossRefGoogle ScholarPubMed
56. Nau, R, Ruchel, R, Mergerian, H, Wegener, U, Winkelmann, T, Prange, HW. Emergence of antibiotic-resistance bacteria during selective decontamination of the digestive tract. J Antimicrob Chemother 1990;25:881883.CrossRefGoogle ScholarPubMed
57. Wingard, JR, Merz, EG, Rinaldi, MG, Johnson, TR, Karp, JE, Saral, R. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991;325:12741277.CrossRefGoogle ScholarPubMed
58. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1992;34:58. Medical Letter.Google Scholar
59. Hill, RL, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988;22:377384.CrossRefGoogle ScholarPubMed
60. Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S227S.CrossRefGoogle ScholarPubMed
61. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313328.CrossRefGoogle ScholarPubMed
62. Boyce, JM, Jackson, MM, Pugliese, G, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105115.CrossRefGoogle ScholarPubMed
63. Drutz, DJ, vanWay, MH, Schaffner, W, Koenig, MG. Bacterial interference in the therapy of recurrent staphylococcal infections. Multiple abscesses due to the implantation of the 502A strain of Staphylococcus . N Engl J Med 1966;275:11611165.CrossRefGoogle Scholar
64. Light, IJ, Walton, RL, Sutherland, JM, Shinefield, HR, Brackvogel, V. Use of bacterial interference to control a staphylococcal nursery outbreak. Am J Dis Child 1967;113:291300.CrossRefGoogle ScholarPubMed
65. Beck, C, Necheles, H. Beneficial effects of administration of Lactobacillus acidophilus in diarrheal and other intestinal disorders. Am J Gastroenterol 1961;35:522530.Google ScholarPubMed
66. Surawicz, CM, Elmer, GW, Speelman, P, McFarland, LV, Chinn, J, vanBelle, G. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology 1989;96:981988.CrossRefGoogle ScholarPubMed
67. Tvede, M, Rask-Madsen, J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet 1989;i:11561160.CrossRefGoogle Scholar
68. Fekety, R, Shah, AB. Diagnosis and treatment of Clostridium difficile colitis. JAMA 1993;269:7175.CrossRefGoogle ScholarPubMed
69. Crocker, IC, Liu, WK, Byrne, PO, Elliott, TSJ. A novel electrical method for the prevention of microbial colonization of intravascular cannulae. J Hosp Infect 1992;22:717.CrossRefGoogle ScholarPubMed
70. Segura, M, Alia, C, Valverde, J, Franch, G, Rodriguez, JMT, Sitges-Serra, A. Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis. J Clin Microbiol 1990;28:25512554.CrossRefGoogle Scholar
71. Maki, DG, Cobb, L, Garman, JK, Shapiro, J, Ringer, M. An attachable silver-impregnated cuff for prevention of infection with central venous catheter. Am J Med 1988;85:307315.CrossRefGoogle Scholar
72. Kamal, GD, Pfaller, MA, Rempe, LE, Jebson, PJR. Reduced intravascular catheter infection by antibiotic bonding. JAMA 1991;265:23642368.CrossRefGoogle ScholarPubMed
73. Kropec, A, Huebner, J, Frank, U, Lemmen, S, Hirt, U, Daschner, FD. In vitro activity of sodium bisulfite and heparin against staphylococci: new strategies in the treatment of catheter-related infection. J Infect Dis 1993;168:235237.CrossRefGoogle ScholarPubMed
74. Mermel, LA, Stolz, SM, Maki, DG. Surface antimicrobial activity of heparin-bonded and antiseptic-impregnated vascular catheters. J Infect Dis 1993;167:920924.CrossRefGoogle ScholarPubMed
75. Bruderer, U, Cryz, SJ Jr, Schaad, UB, Deusinger, M, Que, JU, Lang, AB. Affinity constants of naturally acquired and vaccineinduced anti-Pseudomonas aeruginosa antibodies in healthy adults and cystic fibrosis patients. J Infect Dis 1992;166:344349.CrossRefGoogle ScholarPubMed
76. Pennington, JE. Impact of molecular biology on Pseudomonas aeruginosa immunization. J Hosp Infect 1988;11(suppl A):96102.CrossRefGoogle ScholarPubMed
77. Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to lategeneration cephalosporins. Ann Intern Med 1993;119:353358.CrossRefGoogle ScholarPubMed
78. Rice, LB, Willey, SH, Papanicolaou, GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:21932199.CrossRefGoogle Scholar
79. Naumovski, L, Quinn, JP, Miyashiro, D, et al. Outbreak of ceftazidime resistance due to a novel extended-spectrum betalactamase in isolates from cancer patients. Antimicrob Agents Chemother 1992;36:19911996.CrossRefGoogle ScholarPubMed
80. Brismar, BO, Edlund, C, Malmborg, A-S, Nord, CE. Ecological impact of antimicrobial prophylaxis on intestinal microflora in patients undergoing colorectal surgery. Scand J Infect Dis 1990;70:2530.Google ScholarPubMed