Abstract
BackgroundThe major reservoir of carbapenemase-producing Enterobacteriaceae (CPE) is the gastrointestinal tract of colonized patients. Colonization is silent and may last for months, but the risk of infection by CPE in colonized patients is significant.MethodsEight long-term intestinal carriers of OXA-48-producing Enterobacteriaceae (OXA-PE) were treated during 3 weeks with daily oral lactitol (Emportal®), Bifidobacterium bifidum and Lactobacillus acidophilus (Infloran®). Weekly stool samples were collected during the treatment period and 6 weeks later. The presence of OXA-PE was investigated by microbiological cultures and qPCR.ResultsAt the end of treatment (EoT, secondary endpoint 1), four of the subjects had negative OXA-PE cultures. Three weeks later (secondary endpoint 2), six subjects were negative. Six weeks after the EoT (primary endpoint), three subjects had negative OXA-PE cultures. The relative intestinal load of OXA-PE decreased in all the patients during treatment.ConclusionsThe combination of prebiotics and probiotics was well tolerated. A rapid reduction on the OXA-PE intestinal loads was observed. At the EoT, decolonization was achieved in three patients.Clinical Trials Registration: NCT02307383. EudraCT Number: 2014-000449-65.
Highlights
OXA-48-producing Enterobacteriaceae (OXA-PE) are part of the global epidemic of carbapenemase-producing Enterobacteriaceae (CPE), a problem that has spread to many hospitals around the world
Study design We designed a single arm, open label, pilot clinical trial with long-term carriers of OXA-PE to evaluate the efficacy of the oral administration of probiotics (Infloran®, Bifidobacterium bifidum and Lactobacillus acidophilus, 2 × 109 CFU tid–po) and prebiotics (Emportal®, lactitol 10 g tid) during 3 weeks, in order to evaluate intestinal decolonization
Inclusion criteria were subjects between 18 and 75 years old that had been colonized by OXA-PE during a previous hospitalization, continued being colonized for more than 6 months and had a positive screening of OXA-PE upon recruitment
Summary
OXA-48-producing Enterobacteriaceae (OXA-PE) are part of the global epidemic of carbapenemase-producing Enterobacteriaceae (CPE), a problem that has spread to many hospitals around the world. The major reservoir of CPE is the gastrointestinal tract of the colonized patients This might complicate the control of outbreaks since colonization may be silent and may last for months [2, 3]. One supportive measure for the control of colonization is selective intestinal decontamination of CPE by oral non-absorbable antibiotics active against aerobic gram-negative rods (generally colistin and aminoglycosides). This measure is used as a prophylaxis to prevent intestinal translocations in neutropenic patients, and for prevention of pneumonia associated with mechanical ventilation in intensive care units. The major reservoir of carbapenemase-producing Enterobacteriaceae (CPE) is the gastrointestinal tract of colonized patients. Colonization is silent and may last for months, but the risk of infection by CPE in colonized patients is significant
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