Isabel Machuca1, Belén Gutiérrez-Gutiérrez2, Salvador Pérez Cortés3, Irene Gracia-Ahufinger4, Josefina Serrano5, María Dolores Madrigal6, José Barcala3, Fernando Rodríguez-López4, Jesús Rodríguez-Baño7, Julián Torre-Cisneros1. 1. Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain. 2. Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena and Virgen del Rocío - IBiS, and Department of Medicine, Universidad de Sevilla, Sevilla, Spain. 3. Unit of Infectious Diseases, Hospital Universitario de Jerez, Cádiz, Spain. 4. Unit of Microbiology, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain. 5. Unit of Haematology, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain. 6. Unit of Haematology, Hospital Universitario de Jerez, Cádiz, Spain. 7. Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena and Virgen del Rocío - IBiS, and Department of Medicine, Universidad de Sevilla, Sevilla, Spain jesusrb@us.es.
Abstract
OBJECTIVES: Invasive infections caused by KPC-producing Klebsiella pneumoniae (KPCKP) are associated with very high mortality. Because infection is usually preceded by rectal colonization, we investigated if decolonization therapy (DT) with aminoglycosides had a protective effect in selected patients. METHODS: Patients with rectal colonization by colistin-resistant KPCKP who were at high risk of developing infection (because of neutropenia, surgery, previous recurrent KPCKP infections or multiple comorbidities) were followed for 180 days. Cox regression analysis including a propensity score was used to investigate the impact of the use of two intestinal decolonization regimens with oral aminoglycosides (gentamicin and neomycin/streptomycin) on mortality, risk of KPCKP infections and microbiological success. The study was registered with ClinicalTrials.gov (NCT02604849). RESULTS: The study sample comprised 77 colonized patients, of which 44 (57.1%) received DT. At 180 days of follow-up, decolonization was associated with a lower risk of mortality in multivariate analyses (HR 0.18; 95% CI 0.06-0.55) and a lower risk of KPCKP infections (HR 0.14; 95% CI 0.02-0.83) and increased microbiological success (HR 4.06; 95% CI 1.06-15.6). Specifically, gentamicin oral therapy was associated with a lower risk of crude mortality (HR 0.15; 95% CI 0.04-0.54), a lower risk of KPCKP infections (HR 0.86; 95% CI 0.008-0.94) and increased microbiological response at 180 days of follow-up (HR 5.67; 95% CI 1.33-24.1). Neomycin/streptomycin therapy was only associated with a lower risk of crude mortality (HR 0.22; 95% CI 0.06-0.9). CONCLUSIONS: Intestinal decolonization with aminoglycosides is associated with a reduction in crude mortality and KPCKP infections at 180 days after initiating treatment.
OBJECTIVES:Invasive infections caused by KPC-producing Klebsiella pneumoniae (KPCKP) are associated with very high mortality. Because infection is usually preceded by rectal colonization, we investigated if decolonization therapy (DT) with aminoglycosides had a protective effect in selected patients. METHODS:Patients with rectal colonization by colistin-resistant KPCKP who were at high risk of developing infection (because of neutropenia, surgery, previous recurrent KPCKP infections or multiple comorbidities) were followed for 180 days. Cox regression analysis including a propensity score was used to investigate the impact of the use of two intestinal decolonization regimens with oral aminoglycosides (gentamicin and neomycin/streptomycin) on mortality, risk of KPCKP infections and microbiological success. The study was registered with ClinicalTrials.gov (NCT02604849). RESULTS: The study sample comprised 77 colonized patients, of which 44 (57.1%) received DT. At 180 days of follow-up, decolonization was associated with a lower risk of mortality in multivariate analyses (HR 0.18; 95% CI 0.06-0.55) and a lower risk of KPCKP infections (HR 0.14; 95% CI 0.02-0.83) and increased microbiological success (HR 4.06; 95% CI 1.06-15.6). Specifically, gentamicin oral therapy was associated with a lower risk of crude mortality (HR 0.15; 95% CI 0.04-0.54), a lower risk of KPCKP infections (HR 0.86; 95% CI 0.008-0.94) and increased microbiological response at 180 days of follow-up (HR 5.67; 95% CI 1.33-24.1). Neomycin/streptomycin therapy was only associated with a lower risk of crude mortality (HR 0.22; 95% CI 0.06-0.9). CONCLUSIONS: Intestinal decolonization with aminoglycosides is associated with a reduction in crude mortality and KPCKP infections at 180 days after initiating treatment.
Authors: O Lima; A Sousa; A Filgueira; M Carmen González-Novoa; Celina Domínguez-López; M Ávila-Nuñez; M Represa; P Rubiñán; L Martínez-Lamas; Sonia Pérez-Castro; M Rubianes; M T Pérez-Rodríguez Journal: Eur J Clin Microbiol Infect Dis Date: 2022-10-07 Impact factor: 5.103
Authors: Elena Pérez-Nadales; Ángela Cano; Manuel Recio; María José Artacho; Julia Guzmán-Puche; Antonio Doblas; Elisa Vidal; Clara Natera; Luis Martínez-Martínez; Julian Torre-Cisneros; Juan José Castón Journal: BMJ Open Date: 2022-04-06 Impact factor: 2.692