Eradication of carbapenem-resistant Enterobacteriaceae gastrointestinal colonization with nonabsorbable oral antibiotic treatment: A prospective controlled trial

Ilana Oren, Hannah Sprecher, Renato Finkelstein, Salim Hadad, Ami Neuberger, Keatam Hussein, Ayelet Raz-Pasteur, Noa Lavi, Elias Saad, Israel Henig, Netanel Horowitz, Irit Avivi, Noam Benyamini, Riva Fineman, Yishai Ofran, Nuhad Haddad, Jacob M. Rowe, Tsila Zuckerman

Research output: Contribution to journalArticlepeer-review

Abstract

Background Carbapenem-resistant Enterobacteriaceae (CRE) are emerging. In attempt to eradicate CRE colonization, we conducted a semirandomized, prospective, controlled trial using oral nonabsorbable antibiotics. Methods Consecutive hospitalized CRE carriers were studied. Patients whose rectal isolates were gentamicin sensitive but colistin resistant were treated with gentamicin. Patients whose isolates were colistin sensitive but gentamicin resistant were treated with colistin. Patients whose isolates were sensitive to both drugs were randomized to 3 groups of oral antibiotic treatment: gentamicin, colistin, or both. Patients whose isolates were resistant to both drugs, and those who did not consent, were followed for spontaneous eradication. Results One hundred fifty-two patients were included; 102 were followed for spontaneous eradication for a median duration of 140 days (controls), and 50 received 1 of the 3 drug regimens: gentamicin, 26; colistin, 16; both drugs, 8, followed for a median duration of 33 days. Eradication rates in the 3 treatment groups were 42%, 50%, and 37.5%, respectively, each significantly higher than the 7% spontaneous eradication rate in the control group (P <.001, P <.001, and P =.004, respectively) with no difference between the regimens. No significant adverse effects were observed. Conclusion Oral antibiotic treatment with nonabsorbable drugs to which CRE is susceptible appears to be an effective and safe for eradication of CRE colonization and, thereby, may reduce patient-to-patient transmission and incidence of clinical infection with this difficult-to-treat organism.

Original languageEnglish
Pages (from-to)1167-1172
Number of pages6
JournalAmerican Journal of Infection Control
Volume41
Issue number12
DOIs
StatePublished - Dec 2013
Externally publishedYes

Keywords

  • Colistin
  • Gentamicin
  • Rectal carriage
  • SDD

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