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The Role of Colonization in the Pathogenesis of Nosocomial Infections

Published online by Cambridge University Press:  02 January 2015

Marc J.M. Bonten  and
Robert A. Weinstein
Marc J.M. Bonten*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Division of Infectious Diseases, Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois
*
Division of Infectious Diseases, Room 121 Durand, Cook County Hospital, 1835 W Harrison St, Chicago, IL 60612
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Abstract

The close relationship between colonization and the development of nosocomial infections has been demonstrated. Patient-related factors, such as underlying illness for all major sites of infection and advanced age, and pathogen-related factors, such as the ability of bacteria to adhere to epithelial cells, play the major roles in the pathogenesis of colonization. However, exact mechanisms of colonization have not been elucidated, and modulation of bacterial adherence as a method of infection prevention remains experimental. Current methods of infection prevention, therefore, focus either on preventing growth of colonizing microorganisms or on preventing patient-pathogen contact. Topical antibiotics have been used as a method of colonization prevention. However, their effectiveness may be limited by increases in antibiotic resistance; moreover, the effects on patient outcome are controversial. Maintenance of the physiologic mucosal environment using nonantimicrobial agents seems a promising approach, but only a few studies demonstrating efficacy have been published. Prevention of colonization still must rely heavily on basic infection control measures to prevent contact between patient and pathogen.

Type
Symposium: Nosocomial Colonization
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 3 , March 1996 , pp. 193 - 200
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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References

1. Johanson, WG Jr, Higuchi, JH, Chaudhuri, TR, Woods, DE. Bacterial adherence to epithelial cells in bacillary colonization of the respiratory tract. Am Rev Respir Dis 1980;121:55–63.Google ScholarPubMed
2. Todd, TRJ, Franklin, A, Mankinen-Irvin, P, Gurman, G, Irvin, RT. Augmented bacterial adherence to tracheal epithelial cells is associated with gram-negative pneumonia in an intensive care unit population. Am Rev Respir Dis 1989;140:1585–1589.CrossRefGoogle Scholar
3. Johanson, WG, Pierce, AK, Sanford, JP. Changing pharyngeal bacterial flora of hospitalized patients. N Engl J Med 1969;281:1137–1140.10.1056/NEJM196911202812101Google Scholar
4. Bonten, MJM, Gaillard, CA, Wouters, EFM, van Tiel, FH, Stobberingh, EE, van der Geest, S. Problems in diagnosing nosocomial pneumonia in mechanically ventilated patients: a review. Crit Care Med 1994;22:1683–1691.Google Scholar
5. Bonten, MJM, Gaillard, CA, van Tiel, FH, Smeets, HGW, van der Geest, S, Stobberingh, EE. The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest 1994;105:878–884.CrossRefGoogle Scholar
6. Bonten, MJM, Gaillard, CA, van der Geest, S, et al. The role of intragastric acidity and stress ulcer prophylaxis on colonization and infection in mechanically ventilated patients. Am J Respir Crit Care Med. In press.Google Scholar
7. LaForce, FM, Hopkins, J, Trow, R. Human oral defenses against gram-negative rods. Am Rev Respir Dis 1976;114:929.Google Scholar
8. Sveinbjörnsdóttir, S, Gudmundsson, S, Briem, H. Oropharyngeal colonization in the elderly. Eur J Clin Microbiol Infect Dis 1991;10:959–963.CrossRefGoogle ScholarPubMed
9. Woods, DE. Role of fibronectin in the pathogenesis of gram-negative bacillary pneumonia. Rev Infect Dis 1987;9(suppl):386S–390S.Google Scholar
10. Mason, CM, Bawdon, RE, Pierce, AK, Dal Nogare, AR. Fibronectin is not detectable on the intact buccal epithelial surface of normal rats or humans. Am J Respir Cell Mol Biol 1990;3:563–570.Google Scholar
11. Palmer, LB, Merrill, WW, Niederman, MS. Bacterial adherence to respiratory-tract cells: relationship between in vivo and in vitro pH and bacterial attachment. Am Rev Respir Dis 1986;133:784.Google ScholarPubMed
12. Mason, CM, Nelson, S, Summer, WR. Bacterial colonization: pathogenesis and clinical significance. Immunology and Allergy Clinics of North America 1993;13:93–108.Google Scholar
13. Lamblin, G, Lhermitte, M, Klein, A. The carbohydrate diversity of human respiratory mucins: a protection of the underlying mucosa. Am Rev Respir Dis 1991;144(suppl):19S–24S.Google Scholar
14. Nungester, WJ, Jourdonais, LF. Mucin as an aid in the experimental production of lobar pneumonia. J Infect Dis 1936;59:258–265.CrossRefGoogle Scholar
15. Vishwanath, R, Ramphal, R, Guay, C, Desjardin, D, Pier, GB. Respiratory mucin inhibition of the opsonophagocytic killing of Pseudomonas aeruginosa. Infect Immun 1988;56:2218–2222.Google Scholar
16. Clasener, HAL, Vollaard, EJ, van Saene, HKF. Long-term prophylaxis of infection by selective decontamination in leukopenia and in mechanical ventilation. Rev Infect Dis 1987;9:295–328.Google Scholar
17. 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;156:363–368.Google Scholar
18. Olson, B, Weinstein, RA, Nathan, C, Chamberlin, W, Kabins, SA. Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 1984;150:808–816.Google Scholar
19. Heyland, D, Mandell, LA. Gastric colonization by gram-negative bacilli and nosocomial pneumonia in the intensive care unit patient: evidence for causation. Chest 1992;101:187–193.Google Scholar
20. Tryba, M. The gastropulmonary route of infection—fact or fiction? Am J Med 1991;91(suppl 2A):135S–146S.10.1016/0002-9343(91)90466-BCrossRefGoogle ScholarPubMed
21. Reusser, P, Zimmerli, W, Scheidegger, D, Marbet, GA, Buser, M, Gyr, K. Role of gastric colonization in nosocomial infections and endotoxemia: a prospective study in neurosurgical patients on mechanical ventilation. J Infect Dis 1989;160:414–421.10.1093/infdis/160.3.414CrossRefGoogle ScholarPubMed
22. Bonten, MJM, Gaillard, CA, Johanson, WG Jr, et al. Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 1994;150:1332–1340.CrossRefGoogle Scholar
23. Widmer, AF, Wenzel, RP, Trilla, A, Bale, MJ, Jones, RN, Doebbeling, BN. Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a healthcare worker. Clin Infect Dis 1993;16:372–376.Google Scholar
24. Rhinehart, E, Smith, NE, Wennerstein, C, et al. Rapid dissemination of beta-lactamase producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infanttoddler surgical ward. N Engl J Med 1990;323:1814–1818.Google Scholar
25. Stamey, TA, Timothy, M, Millar, M. Recurrent urinary infections in adult women. The role of intraoital enterobacteria. Calif Med 1971;115:1–19.Google Scholar
26. Kaye, D. Antibacterial activity of human urine. J Clin Invest 1968;47:2374–2390.Google Scholar
27. Eschenbach, DA, Davick, PR, Williams, BL. Prevalence of hydrogen peroxidase-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol 1989;27:251–256.Google Scholar
28. Raz, R, Stamm, WE. A controlled study of intravaginal estrol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993;329:753–756.Google Scholar
29. Asscher, AW, Sussman, M, Weiser, R. Urinary Tract Infection. In: O'Grady, F, Brumfitt, W, eds. London, England: Oxford University Press; 1968:3–13.Google Scholar
30. Roberts, AP, Philips, R. Bacteria causing symptomatic urinary tract infection or bacteriuria. J Clin Pathol 1979;32:492–496.Google Scholar
31. Iwahi, T, Abe, Y, Nakao, M. Role of type 1 fimbriae in the pathogenesis of ascending urinary tract infection induced by Escherichia coli in mice. Infect Immun 1995.Google Scholar
32. Leffler, H, Savnborg-Eden, C. Glycolipid receptors for uropathogenic Escherichia coli binding to human erythrocytes and uroepithelial cells. Infect Immun 1981;34:920–929.Google Scholar
33. Mobley, HCT, Chipperdale, GR, Teriney, JH. Mitral regurgitation haemagglutination of Providencia stuartii correlates with adherence to catheters and with persistence of catheter-associated bacteriuria. J Infect Dis 1988;157:264.10.1093/infdis/157.2.264Google Scholar
34. Silverblatt, FS. Host-parasite interaction in the rat renal pelvis: a possible role of pili in the pathogenesis of pyelonephritis. J Exp Med 1974;140:1696.Google Scholar
35. Fader, FC, Davis, CP. Effect of piliation on Klebsiella pneumoniae infection in rat bladders. Infect Immun 1980;30:554–561.Google Scholar
36. Aly, R, Shinefield, HR, Litz, C. Role of teichoic acid in the binding of Staphylococcus aureus to nasal epithelial cells. J Infect Dis 1980;141:463–465.CrossRefGoogle ScholarPubMed
37. Waldvogel, FA. Staphylococcus aureus (including Toxic Shock Syndrome). In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practices of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:1754–1776.Google Scholar
38. Hudson, IRB. The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect 1994;27:81–98.Google Scholar
39. Casewell, MW, Hill, RLR. The carrier state: methicillin-resistant Staphylococcus aureus . J Antimicrob Chemother 1986;18(suppl A):1–12.Google Scholar
40. Casewell, M, Philips, I. Hands as a route of transmission for Klebsiella species. Brit Med J 1977;2:1315.10.1136/bmj.2.6098.1315Google Scholar
41. Simmons, B, Bryant, J, Neiman, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589–594.Google Scholar
42. Garner, JS, Favero, MS. CDC guideline for handwashing and hospital environmental control. Infect Control 1986;7:231–243.Google ScholarPubMed
43. Wiener, J, Weinstein, RA. Infection control methods. In: Niederman, MS, Sarosi, GA, Glassroth, J, eds. Respiratory Infections: A Scientific Basis for Management. Philadelphia, PA: W.B. Saunders Co; 1994:565–577.Google Scholar
44. Stoutenbeek, CP, van Saene, HKF, Miranda, DR, Zandstra, DF. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 1984;10:185–192.10.1007/BF00259435CrossRefGoogle ScholarPubMed
45. Gastinne, H, Wolff, M, Delatour, F, Faurisson, F, Chevret, S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992;326:594–599.Google Scholar
46. Bonten, MJM, van Tiel, FH, van der Geest, S, Stobberingh, EE, Gaillard, CA. Enterococcus faecalis pneumonia complicating topical antimicrobial prophylaxis. N Engl J Med 1993;328:209–210.CrossRefGoogle ScholarPubMed
47. Hammond, JMJ, Potgieter, PD, Saunders, GL, Forder, AA. Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992;340:5–9.CrossRefGoogle ScholarPubMed
48. Rocha, LA, Martin, MJ, Pita, S, et al. Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract: a randomized, double-blind, placebo-controlled study. Intensive Care Med 1992;18:398–404.Google Scholar
49. Daschner, FD. Emergence of resistance during selective decontamination of the digestive tract. Eur J Clin Microbiol Infect Dis 1992;11:1–3.Google Scholar
50. Allaouchiche, B, Guillaume, C, Godard, J. Emergence of tobramycin resistance during selective decontamination of the digestive tract. In: Proceedings of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy. 1992;352. Abstract.Google Scholar
51. Slocombe, B, Perry, C. The antimicrobial activity of mupirocin—an update on resistance. J Hosp Infect 1991;19(suppl B):19–25.Google Scholar
52. Working Party Report. Revised guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus . J Hosp Infect 1990;16:351–377.Google Scholar
53. Doebbeling, BN, Breneman, DL, Neu, HC, et al. Elimination of Staphylococcus aureus nasal carriage in healthcare workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466–474.Google Scholar
54. Boelaert, JR, De Smedt, RA, De Baere, YA. The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in hemodialysis patients. Nephrol Dial Transplant 1989;4:278–281.Google Scholar
55. Leigh, DA, Joy, G. Treatment of familial staphylococcal infection: comparison of mupirocin nasal ointment and chlorhexidine/neomycin (Naseptin) cream in eradication of nasal carriage. J Antimicrob Chemother 1993;31:909–917.Google Scholar
56. Kluytmans, J, Maat, A, Manders, M, Wagenvoort, J. Reduction of post-operative wound infection by elimination of nasal carriage of Staphylococcus aureus. Proceedings of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy 1992;1267:322. Abstract.Google Scholar
57. Tryba, M. Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med 1987;83(suppl 3B):117–124.CrossRefGoogle ScholarPubMed
58. Driks, MR, Craven, DE, Celli, BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med 1987;317:1376–1382.Google Scholar
59. Eddleston, JM, Vohra, A, Scott, P, et al. A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients. Crit Care Med 1991;19:1491–1496.Google Scholar
60. Prod'hom, G, Leuenberger, P, Koerfer, J, et al. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer: a randomized controlled trial. Ann Intern Med 1994;120:653–662.Google Scholar
61. Simms, HH, DeMaria, E, McDonald, L, Peterson, D, Robinson, A, Burchard, KW. Role of gastric colonization in the development of pneumonia in critically ill trauma patients: results of a prospective randomized trial. J Trauma 1991;31:531–536.Google Scholar
62. Lee, B, Chang, RWS, Jacobs, S. Intermittent nasogastric feeding: a simple and effective method to reduce pneumonia among ventilated ICU patients. Clin Intensive Care 1990;1:100–102.Google Scholar
63. Bonten, MJM, Gaillard, CA, Hoefnagels, J, et al. The influence of intermittent enteral feeding on intragastric acidity on colonization of stomach and oropharynx. Proceedings of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; Orlando, FL; 1994. Abstract.Google Scholar
64. Spilker, CA, Hinthorn, DR, Pingleton, SK. Intermittent enteral feeding and gastric colonization in critically ill patients. Am Rev Respir Dis 1993;147:A200. Abstract.Google Scholar
65. Heyland, D, Bradley, C, Mandell, LA. Effect of acidified enteral feedings on gastric colonization in the critically ill patients. Crit Care Med 1992;20:1388–1394.Google Scholar
66. Montecalvo, MA, Steger, KA, Farber, HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal feedings. Crit Care Med 1992;20:1377–1387.Google Scholar
67. Rutter, JM, Jones, GW. Protection against enteric disease caused by Escherichia coli—a model for vaccination with a virulence determinant? Nature 1973;242:531.10.1038/242531a0CrossRefGoogle ScholarPubMed
68. Silverblatt, FJ, Cohen, LS. Antipili antibody affords protection against experimental ascending pyelonephritis. J Clin Invest 1979;64:333.Google Scholar
69. Ofek, I, Beachey, EH, Eisenstein, BI. Suppression of bacterial adherence by subminimal inhibitory concentrations of betalactam and aminoglycoside antibiotics. Rev Infect Dis 1979;1:832.Google Scholar