Intestinal decolonization of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL): a retrospective observational study in patients at risk for infection and a brief review of the literature

BMC Infectious Diseases

Winfried V. Kern⁴  Jürgen A. Bohnert²  Annerose Serr¹  Katja de With³  M. Fabian Küpper⁴  Siegbert Rieg⁴ 

[1] Department of Microbiology, Albert-Ludwigs-University Hospital & Medical Center, Freiburg, Germany;Present address: Institute of Medical Microbiology, University Hospital, Jena, Germany;Present address: Clinical Infectious Diseases and Antibiotic Stewardship Unit, Carl Carus University Hospital, Dresden, Germany;Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, Freiburg, D-79106, Germany

关键词: Paromomycin;    Rifaximin;    Colistin;    Decontamination;    Eradication;    ESBL;   

Others  :  1232744
DOI  :  10.1186/s12879-015-1225-0

 received in 2015-03-11, accepted in 2015-10-19,  发布年份 2015

【 摘 要 】

Background

Multidrug-resistant Escherichia coli and other enteric bacteria producing extended-spectrum β-lactamases (ESBL) have emerged as an important cause of invasive infection. Targeting the primary (intestinal) niche by decolonization may be a valuable approach to decrease the risk of relapsing infections and to reduce transmission of ESBL-producing enteric pathogens.

Methods

In a retrospective observational study we evaluated the efficacy of intestinal decolonization treatment using orally administered colistin or other non-absorbable agents given for 2 to 4 weeks in adult patients with previous relapsing infection and persistent intestinal colonization with ESBL-positive Enterobacteriaceae (ESBL-E). Eradication success was defined as negative rectal swab or stool culture at the end of treatment and at follow up-2 weeks after treatment discontinuation.

Results

First-line decolonization treatment led to eradication of ESBL-E in 19/45 patients (42 %, 7/18 low-dose [4 × 1 million units] colistin, 3/12 high-dose [4 × 2 million units] colistin, 9/15 rifaximin [2 × 400 mg]), and secondary/salvage treatment was successful in 8/13 patients (62 %, 20 treatment episodes). Late follow-up showed that 7/13 patients (54 %) with successful initial or salvage decolonization became recolonized within 3 months after post-treatment assessment while all eight of the patients failing initial or salvage decolonization treatment with late follow-up remained colonized. A narrative review of the literature confirms the limited efficacy of non-absorbable antibiotics including conventional selective digestive tract decolonization (SDD)-like combination regimens for eradicating multidrug-resistant enteric bacteria from the intestinal tract.

Conclusions

At present, there is no clear evidence of a significant decolonization efficacy using single-drug treatment with oral non-absorbable antibiotics. More effective regimens are needed and a better definition of at risk patients is required for planning meaningful randomized controlled studies in this field.

【 授权许可】

   
2015 Rieg et al.

【 图 表 】

Fig. 1.

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