Abstract
Selective digestive decontamination has been found to prevent pulmonary infections in mechanically ventilated patients. The aims of this study were: 1) to determine whether detectable levels of antibiotics could be found in bronchial tree secretions of patients receiving SDD, and 2) to evaluate antibiotic serum levels. In 15 patients receiving mechanical ventilation and SDD for 10 days or more, tobramycin and amphotericin B levels were determined every 3 days in the following specimems: tracheal aspirates, distal bronchial secretions and blood samples. 82% of tracheal aspirates contained detectable (>0.18 mg/l), tobramycin concentrations; the levels varied widely between patients and large day-to-day variations were observed. Every patient had at least 1 tracheal aspirate with tobramycin level higher than 0.5 mg/l during his course. 40% of distal specimens contained detectable tobramycin levels (10 patients). Serum determinations showed detectable concentration of tobramycin in 50% of the specimens (9 patients). Two patients with renal failure had serum tobramycin levels higher than 2 mg/l. In 13 tracheal aspirates cultures were positive and 15 species were isolated; 13 had a MIC higher than the corresponding tobramycin level in tracheal secretions. We conclude than substantial levels of antibiotics can be found frequently in respiratory tract specimens of patients receiving SDD. Therefore, the usual microbiological criteria used to assess respiratory tract infection may be unreliable in this setting and other criteria may be required. Follow-up of antibiotic serum levels is required, especially in patients with renal failure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1988) Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 16:1087–1093
Ledingham IM, Estaway AT, McKay JC, Alcock SR, McDonald JC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 9:785–786
Stoutenbeek CP, Van Saene HK, Miranda DR, Zandstra DF, Langrehr D (1984) The effect of oropharyngeal decontamination using topical non absorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357–364
Sydow M, Burchardi H, Fraatz T, Crozier TA, Seyde W, Ruchel R (1988) Prevention of nosocomial pneumonia in mechanical ventilated patients in a respiratory intensive care unit. Intensive Care Med 14 [Suppl]: 310 (Abstract)
Ulrich C, Harinck-De Weerd NC, Bakker NC, Jacz K, De Ridder D, De Ridder VA (1989) Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infection: a prospective randomised study. Intensive Care Med 15:424
Unertl K, Buckdeschel G, Selbmann HC, Jensen U, Forst H, Lenhart FP, Peter K (1987) Prevention of colonisation and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 13:106–113
Van Uffelen R, Rommes J, Van Saene HKF (1987) Preventing lower airway colonisation and infection in mechanically ventilated patients. Crit Care Med 15:99–102
Spray SB, Zuidema GD, Cameron JL (1976) Aspiration penumonia incidence of aspiration with endotracheal tube. Am J Surg 131:701–708
Polak AM (1979) Pharmacokinetics of amphotericin B and flucytosine. Postgrad Med J 55:667–670
Chastre J, Viau F, Brun P, Pierre J, Dauge MC, Bouchama A, Akesbi A, Gibert C (1984) Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infection in ventilated patient. A Rev Respir Dis 130:924–929
Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C (1989) Nosocomial pneumonia in patient receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protracted specimen brush and quantitative cultures techniques. Am Rev Respir Dis 139:877–884
Wimberley NW, Bass JB, Boyd BW (1982) Use of bronchoscopic protected catheter brush for the diagnosis of pulmonary infection. Chest 81:556–562
Johanson WG, Seidenfeld JJ, Gomez P, De Los Santos R, Coalson JJ (1988) Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. Am Rev Respir Dis 137:259–264
Sciarra M, Cavaliere F, Crociani E, Ciuni C, Proietti R (1988) Tobramicin serum levels during selective decontamination of the digestive tract. Intensive Care Med 14:310 (Abstract)
Clasener HA, Vollaard EJ, Van Saene HK (1987) Long-term prophylaxis of infection by selective decontamination in leucopenia and in mechanical ventilation. Rev Infect Dis 2:295–327
Powell SH, Thomason WL, Luthe MA, Stern RG, Grossiklaus DA, Bloxham DD, Groden DL, Jacobs MR, Di Scenna AO, Cash HA, Klinder JD (1983) Once dayly vs continuous aminoglycosides dosing: efficacy and toxicity in animal and clinical studies of gentamicin, netilmicin and tobramycin. J Infect Dis 147:918–932
Ficher MA, Talbot GH, Maislim G, Mc Keon BP, Tynan KP, Strom BL (1989) Risk factors for amphotericin B — associated nephrotoxicity. Am J Med 87:547–552
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gastinne, H., Wolff, M., Lachatre, G. et al. Antibiotic levels in bronchial tree and in serum during selective digestive decontamination. Intensive Care Med 17, 215–218 (1991). https://doi.org/10.1007/BF01709880
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709880