{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:58:34Z","timestamp":1791122314527,"version":"4.1.0"},"reference-count":28,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T00:00:00Z","timestamp":1372636800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Selective decontamination of the digestive tract (SDD) selectively eradicates aerobic Gram-negative bacteria (AGNB) by the enteral administration of oral nonabsorbable antimicrobial agents, i.e., colistin and tobramycin. We retrospectively investigated the impact of SDD, applied for 5 years as part of an infection control program for the control of an outbreak with extended-spectrum beta-lactamase (ESBL)-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Klebsiella pneumoniae<\/jats:named-content>\n                    in an intensive care unit (ICU), on resistance among AGNB. Colistin MICs were determined on stored ESBL-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates using the Etest. The occurrence of both tobramycin resistance among pathogens intrinsically resistant to colistin (CIR) and bacteremia caused by ESBL-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    and CIR were investigated. Of the 134 retested ESBL-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates, 28 were isolated before SDD was started, and all had MICs of &lt;1.5 mg\/liter. For the remaining 106 isolated after starting SDD, MICs ranged between 0.5 and 24 mg\/liter. Tobramycin-resistant CIR isolates were found sporadically before the introduction of SDD, but their prevalence increased immediately afterward. Segmented regression analysis showed a highly significant relationship between SDD and resistance to tobramycin. Five patients were identified with bacteremia caused by ESBL-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    before SDD and 9 patients thereafter. No bacteremia caused by CIR was found before SDD, but its occurrence increased to 26 after the introduction of SDD. In conclusion, colistin resistance among ESBL-producing\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates emerged rapidly after SDD. In addition, both the occurrence and the proportion of tobramycin resistance among CIR increased under the use of SDD. SDD should not be applied in outbreak settings when resistant bacteria are prevalent.\n                  <\/jats:p>","DOI":"10.1128\/aac.02634-12","type":"journal-article","created":{"date-parts":[[2013,4,29]],"date-time":"2013-04-29T23:01:41Z","timestamp":1367276501000},"page":"3224-3229","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":157,"title":["Emergence of Colistin Resistance in Enterobacteriaceae after the Introduction of Selective Digestive Tract Decontamination in an Intensive Care Unit"],"prefix":"10.1128","volume":"57","author":[{"given":"Teysir","family":"Halaby","sequence":"first","affiliation":[{"name":"Laboratory for Medical Microbiology and Public Health, Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashwan","family":"al Naiemi","sequence":"additional","affiliation":[{"name":"Laboratory for Medical Microbiology and Public Health, Enschede, The Netherlands"},{"name":"Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Kluytmans","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands"},{"name":"Amphia Hospital, Breda, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Job","family":"van der Palen","sequence":"additional","affiliation":[{"name":"Medical School Twente, Medisch Spectrum Twente, Enschede, and Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M. J. E.","family":"Vandenbroucke-Grauls","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/429323"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/599226"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm305"},{"key":"e_1_3_2_5_2","first-page":"621","article-title":"The in-vitro activity of colistin in gram-negative bacteria","volume":"47","author":"Tan TY","year":"2006","unstructured":"TanTY NgSY. 2006. The in-vitro activity of colistin in gram-negative bacteria. Singapore Med. J. 47:621\u2013624.","journal-title":"Singapore Med. 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