Jjm Vansaene

SELECTIVE DECONTAMINATION OF THE DIGESTIVE-TRACT CONTRIBUTES TO THE CONTROL OF DISSEMINATED INTRAVASCULAR COAGULATION IN SEVERE LIVER IMPAIRMENT

A premature nconate with severe Coxsackic B1 hepatitis acquired in utero developed disseminated intravascular coagulation a few days after birth. The neonate did not respond to conventional treatment. Eradication of aerobic gram-negative bacilli (Enterobacteriaccae) from the gut with oral nonabsorbable polymyxin E and tobramycin (selective decontamination of the digestive tract) was followed by clinical improvement; disseminated intravascular coagulation was controlled. After an unstable convalescence, the neonate recovered and was discharged in good general condition. A correlation between oral feeding, gut carriage of Enterobacteriaceae, fecal endotoxin pool, and platelet counts was observed. The eradication of gut carriage of aerobic gram-negative bacilli was associated with a significant decrease of the intestinal endotoxin pool and paralleled the recovery from thrombocytopenia. Selective decontamination is discussed as a method of possible value for controlling systemic endotoxin-induced symptoms in the critically ill with intestinal endotoxemia.

Enterobacteriaceae suppression by three different oral doses of polymyxin E in human volunteers

Polymyxin E is frequently used as an oral drug for flora suppression of the gastrointestinal canal. The suppression effect is dose dependent because polymyxin E is moderately inactivated by faecal and food compounds. Three oral polymyxin E doses (150, 300, 600 mg daily) were given to six volunteers for 6 days. The Enterobacteriaceae suppression effect was compared by means of the suppression index i.e. ratio of total number of faecal samples free of Enterobacteriaceae to the total number of faecal samples. The impact on the indigenous (mostly anaerobic) flora was measured in four ways: (i) beta-aspartylglycine content; (ii) volatile fatty acid pattern; (iii) yeast overgrowth and (iv) Streptococcus faecalis decrease. Enterobacteriaceae suppression was most successful during 600 mg oral polymyxin E (suppression indices during 150, 300 and 600 mg were 0.32, 0.55 and 0.89 respectively). None of the four markers of indigenous flora alterations were positive. However, using this dosage half of the volunteers suffered rather severe gastrointestinal side-effects. Oral polymyxin E in a dosage of minimum 600 mg daily seems to possess the ideal properties of a flora suppression agent, if the gastrointestinal side-effects could be mitigated.

Effect of chlorhexidine and acetic acid on phagocytosis by polymorphonuclear leucocytes

The effect of two disinfectants, chlorhexidine and acetic acid, on host leucocytes and bacteria was studied. At a concentration of 50 mg/l, chlorhexidine was found to be bactericidal without interfering with leucocyte function. A concentration of 500 mg/l of acetic acid was neither leucotoxic nor bactericidal. Effects equivalent to the aforementioned were achieved in serum by increasing the chlorhexidine concentration by a factor of 20 and the acetic acid concentration by a factor of 5. Acetic acid reduced leucocyte function more rapidly than it killed bacteria. On the basis of these findings, chlorhexidine is to be preferred for local application in burn wounds to prevent colonisation and infection.