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Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

¹ Dept of Emergency, Unit of Anaesthesia and Intensive Care, and ² Unit of Microbiology and Laboratory Medicine, Regional Hospital of Gorizia, Gorizia, and ³ Dept of Public Health and Microbiology, University of Turin, Turin, Italy. ⁴ Dept of Medical Microbiology, University of Liverpool, Liverpool, UK

CORRESPONDENCE: L. Silvestri, Unità Operativa di Anestesia e Rianimazione, Presidio Ospedaliero, Via Vittorio Veneto 171, 34170 Gorizia, Italy. Fax: 39 0481592977, E-mail: lucianosilvestri@yahoo.it

Keywords: Carrier state, intensive care unit, methicillin resistance, pneumonia, Staphylococcus aureus, vancomycin

Received: September 30, 2003
Accepted February 9, 2004

This study was undertaken to assess whether oropharyngeal vancomycin may control oropharyngeal carriage and lower airway infection due to methicillin-resistant Staphylococcus aureus (MRSA) acquired in the intensive care unit (ICU). Secondary endpoints were the emergence of vancomycin-resistant enterococci, vancomycin-intermediate S. aureus and vancomycin consumption.

A total of 84 patients, admitted to a medical/surgical ICU and mechanically ventilated for >72 h, were randomly assigned to control (n=42) or test (n=42) group. Both groups received the protocol of selective decontamination of the digestive tract, including polymyxin E, tobramycin and amphotericin B. Patients in the test group received 0.5 g of a 4% vancomycin gel at 6-h intervals in the oropharynx.

Lower airway infections due to MRSA acquired on the ICU were reduced in the test group, as was oropharyngeal carriage. Neither vancomycin-resistant enterococci nor vancomycin-intermediate S. aureus were isolated from either surveillance or diagnostic samples during the study period. The vancomycin costs were lower in the test group.

This study demonstrates that oropharyngeal vancomycin, which controls intensive care unit-acquired lower airway infections and secondary carriage due to methicillin-resistant Staphylococcus aureus, is cost-effective and safe in terms of vancomycin-resistant enterococci and vancomycin-intermediate Staphylococcus aureus.

This article has been cited by other articles:

				L. Silvestri, H. K.F. van Saene, R. E. Sarginson, and A. Gullo Selective Decontamination of the Digestive Tract and Ventilator-Associated Pneumonia: We Cannot Let Misinformation Go Uncorrected J Intensive Care Med, May 1, 2007; 22(3): 181 - 182. [PDF]

				E. Y. Chan, A. Ruest, M. O Meade, and D. J Cook Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis BMJ, April 28, 2007; 334(7599): 889 - 889. [Abstract] [Full Text] [PDF]

				L. Silvestri, H. K. F. van Saene, M. A. de la Cal, and A. Gullo Adult Hospital and Ventilator-associated Pneumonia Guidelines: Eminence- rather than Evidence-based Am. J. Respir. Crit. Care Med., January 1, 2006; 173(1): 131 - 133. [Full Text] [PDF]

				S W B Newsom MRSA--past, present, future J R Soc Med, November 1, 2004; 97(11): 509 - 510. [Full Text] [PDF]