DECOLONIZATION OF INTESTINAL CARRIAGE OF MDR/XDR GRAM-NEGATIVE BACTERIA WITH ORAL COLISTIN IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Igor Stoma, Igor Karpov, Igor Iskrov, Svetlana Krivenko, Anatoly Uss, Svetlana Vlasenkova, Irina Lendina, Veronika Cherniak, Dmitrii Suvorov
  • Igor Stoma
    Department of Infectious Diseases, Belarusian State Medical University, Minsk, Belarus., Belarus | igor.stoma@gmail.com
  • Igor Karpov
    Belarusian state medical university,
  • Igor Iskrov
    City clinical hospital №9, Minsk, Belarus,
  • Svetlana Krivenko
    City clinical hospital №9, Minsk, Belarus,
  • Anatoly Uss
    City clinical hospital №9, Minsk, Belarus,
  • Svetlana Vlasenkova
    City clinical hospital №9, Minsk, Belarus,
  • Irina Lendina
    City clinical hospital №9, Minsk, Belarus,
  • Veronika Cherniak
    City clinical hospital №9, Minsk, Belarus,
  • Dmitrii Suvorov
    City clinical hospital №9, Minsk, Belarus,

Abstract

Background

Intestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies.

Objectives

The objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies.

Methods

In a tertiary hematology center adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as a decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457.

Results

Short-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17–9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs 12.9%), but overall in the 90-day observation period it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed.

Conclusions

This study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects.

Keywords

multidrug-resistant bacteria, selective oral decolonization, polymyxins, hematology, neutropenia

Full Text:

PDF
HTML
Submitted: 2018-03-08 06:04:38
Published: 2018-05-01 00:00:00
Search for citations in Google Scholar
Related articles: Google Scholar

References

Birgand, G. et al. Duration of colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae after hospital discharge / G. Birgand et al. // American Journal of Infection Control. – 2013. – Vol. 41, № 5. – P. 443–447.

Löhr, I.H. et al. Long-term faecal carriage in infants and intra-household transmission of CTX-M-15-producing Klebsiella pneumoniae following a nosocomial outbreak / I.H. Löhr et al. // The Journal of Antimicrobial Chemotherapy. – 2013. – Vol. 68, № 5. – P. 1043–1048.

Schwaber, M.J. & Carmeli, Y. Carbapenem-resistant Enterobacteriaceae: a potential threat / M.J. Schwaber, Y. Carmeli // JAMA. – 2008. – Vol. 300, № 24. – P. 2911–2913.

Yu, V.L. et al. Virulence characteristics of Klebsiella and clinical manifestations of K. pneumoniae bloodstream infections / V.L. Yu et al. // Emerging Infectious Diseases. – 2007. – Vol. 13, № 7. – P. 986–993.

Denis, B. et al. Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study / B. Denis et al. // International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases. – 2015. – Vol. 39, – P. 1–6.

Freifeld, A.G. et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America / A.G. Freifeld et al. // Clinical Infectious Diseases. – 2011. – Vol. 52, № 4. – P. E56–e93.

Stoma, I. et al. Risk factors for mortality in patients with bloodstream infections during the pre-engraftment period after hematopoietic stem cell transplantation / I. Stoma et al. // Blood Research. – 2016. – Vol. 51, № 2. – P. 102–106.

Saidel-Odes, L. et al. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage / L. Saidel-Odes et al. // Infection Control and Hospital Epidemiology. – 2012. – Vol. 33, № 1. – P. 14–19.

Huttner, B. et al. Decolonization of intestinal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae with oral colistin and neomycin: a randomized, double-blind, placebo-controlled trial / B. Huttner et al. // The Journal of Antimicrobial Chemotherapy. – 2013. – Vol. 68, № 10. – P. 2375–2382.

de Jonge, E. et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial / E. de Jonge et al. // Lancet (London, England). – 2003. – Vol. 362, № 9389. – P. 1011–1016.

Rieg, S. et al. 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 / S. Rieg et al. // BMC infectious diseases. – 2015. – Vol. 15, – P. 475.

Zuckerman, T. et al. SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state / T. Zuckerman et al. // Bone Marrow Transplantation. – 2011. – Vol. 46, № 9. – P. 1226–1230.

Mody, L. et al. Mupirocin-based decolonization of Staphylococcus aureus carriers in residents of 2 long-term care facilities: a randomized, double-blind, placebo-controlled trial / L. Mody et al. // Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. – 2003. – Vol. 37, № 11. – P. 1467–1474.

Weintrob, A. et al. Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults / A. Weintrob et al. // PloS One. – 2015. – Vol. 10, № 5. – P. E0128071.

Magiorakos, A.-P. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance: International standard definitions for acquired resistance / A.-P. Magiorakos et al. // Clinical Microbiology and Infection. – 2012. – Vol. 18, № 3. – P. 268–281.

Wayne PA. Clinical and Laboratory Standards Institute. M100-S17. Performance standards for antimicrobial susceptibility testing; 16th informational supplement. 2007.

The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, version 7.1, 2017, http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_7.1_Breakpoint_Tables.pdf.

Chew, K.L. et al. Colistin and Polymyxin B Susceptibility Testing for Carbapenem-Resistant and mcr-Positive Enterobacteriaceae: Comparison of Sensititre, MicroScan, Vitek 2, and Etest with Broth Microdilution / K.L. Chew et al. // Journal of Clinical Microbiology. – 2017. – Vol. 55, № 9. – P. 2609–2616.

Schulz, K.F. Altman, D.G. & Moher, D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials / K.F. Schulz, D.G. Altman, D. Moher // BMC Medicine. – 2010. – Vol. 8, – P. 18.

Taur, Y. et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation / Y. Taur et al. // Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. – 2012. – Vol. 55, № 7. – P. 905–914.

Taur, Y. & Pamer, E.G. The intestinal microbiota and susceptibility to infection in immunocompromised patients / Y. Taur, E.G. Pamer // Current Opinion in Infectious Diseases. – 2013. – Vol. 26, № 4. – P. 332–337.

Tschudin-Sutter, S. et al. Sites of colonization with extended-spectrum β-lactamases (ESBL)-producing enterobacteriaceae: the rationale for screening / S. Tschudin-Sutter et al. // Infection Control and Hospital Epidemiology. – 2012. – Vol. 33, № 11. – P. 1170–1171.

D’Agata, E.M.C. et al. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci / E.M.C. D’Agata et al. // Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. – 2002. – Vol. 34, № 2. – P. 167–172.

Abstract views:
861

Views:
PDF
23
HTML
90

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


Copyright (c) 2018 Mediterranean Journal of Hematology and Infectious Diseases

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
 
© PAGEPress 2008-2018     -     PAGEPress is a registered trademark property of PAGEPress srl, Italy.     -     VAT: IT02125780185     •     Privacy