Abstract
Background: KPC-producing Klebsiella pneumoniae (KPCKP) is a threat for patients admitted to healthcare institutions.Objectives: To assess the efficacy of several decolonization strategies for KPCKP rectal carriage.Methods: Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak.Results: Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone (n = 26, 35.6%) or followed by a probiotic (n = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), p = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), p = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78–14.7, p = 0.09).Conclusion: In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study.
Highlights
Infections caused by KPC-2 producing Klebsiella pneumoniae (KPCKP) are an increasing threat for patients admitted to healthcare institutions (McConville et al, 2017)
Control group: The control group was composed of colonized patients who did not receive decolonization treatment (DT) as they were discharged before the beginning of the intervention
There were significant differences among groups in the frequency of patients with solid and hematopoietic stem cell transplantation (HSCT) as they were excluded from the Non-absorbable antibiotic regimen (NAA) plus probiotic group (p = 0.022 and 0.039, respectively)
Summary
Infections caused by KPC-2 producing Klebsiella pneumoniae (KPCKP) are an increasing threat for patients admitted to healthcare institutions (McConville et al, 2017). Decolonization therapy, defined as any measure that leads to loss of detectable MDR-GNB carriage at any site, has a very low level of evidence due to the inconsistent results of the studies assessing it In this context, a European guideline with recommendations for decolonizing regimens targeting MDR-GNB carriers in all settings was published in 2019 (Tacconelli et al, 2019). On the basis of the limited evidence of its efficacy in high-risk patients, (Saidel-Odes et al, 2012; Oren et al, 2013) further good-quality clinical studies are needed in order to define more precisely the infection risk in populations such as colonized hematological patients and solid organ transplant recipients These studies should set the basis for designing clinical decolonization trials. KPC-producing Klebsiella pneumoniae (KPCKP) is a threat for patients admitted to healthcare institutions
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