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BMC Infect Dis. 2015 Oct 28;15:475. doi: 10.1186/s12879-015-1225-0.

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.

Author information

1
Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, D-79106, Freiburg, Germany. siegbert.rieg@uniklinik-freiburg.de.
2
Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, D-79106, Freiburg, Germany. marc.kuepper@uniklinik-freiburg.de.
3
Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, D-79106, Freiburg, Germany. katja.dewith@uniklinikum-dresden.de.
4
Center for Chronic Immunodeficiency, Albert-Ludwigs-University Hospital & Medical Center, Freiburg, Germany. katja.dewith@uniklinikum-dresden.de.
5
Present address: Clinical Infectious Diseases and Antibiotic Stewardship Unit, Carl Carus University Hospital, Dresden, Germany. katja.dewith@uniklinikum-dresden.de.
6
Department of Microbiology, Albert-Ludwigs-University Hospital & Medical Center, Freiburg, Germany. annerose.serr@uniklinik-freiburg.de.
7
Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, D-79106, Freiburg, Germany. juergen.bohnert@med.uni-jena.de.
8
Present address: Institute of Medical Microbiology, University Hospital, Jena, Germany. juergen.bohnert@med.uni-jena.de.
9
Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University Hospital & Medical Center, Hugstetter Straße 55, D-79106, Freiburg, Germany. kern@if-freiburg.de.

Abstract

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.

PMID:
26511929
PMCID:
PMC4624661
DOI:
10.1186/s12879-015-1225-0
[Indexed for MEDLINE]
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