RT Journal Article
T1 Proof‑of‑concept study to quantify changes in intestinal loads of KPC-producing Klebsiella pneumoniae in colonised patients following selective digestive decontamination with oral gentamicin.
A1 Perez-Nadales, Elena
A1 Natera, Alejandra M.
A1 Recio-Rufian, Manuel
A1 Guzman-Puche, Julia
A1 Cano, Angela
A1 Frutos-Adame, Azahara
A1 Caston, Juan Jose
A1 Elias-Lopez, Cristina
A1 Romero-Saldaña, Manuel
A1 Lopez-Cerero, Lorena
A1 Martinez-Martinez, Luis
A1 Torre-Cisneros, Julian
K1 Antimicrobial resistance
K1 Bacterial load
K1 Intestinal colonisation
K1 KPC-producing Klebsiella pneumoniae
K1 Selective digestive decontamination
AB To monitor quantitatively the extent of intestinal colonisation by KPC-producing Klebsiella pneumoniae (KPC-Kp) in colonised patients who receive selective digestive decontamination (SDD) with oral gentamicin. We developed a real-time quantitative PCR (qPCR) method for determination of the relative load of blaKPC (RLKPC) within the gut microbiota. Clinical validation was performed using a culture method as the gold standard and receiver operating curve (ROC) analysis. Fifteen patients were observationally and prospectively followed for one year. Clinical, microbiological variables and rectal swab samples were collected at 0 (baseline), 14 and 30 days and monthly thereafter. Clinical validation performed on 111 rectal swab samples demonstrated that the PCR method detected 17% more positives than the culture method. ROC curve analysis documented excellent agreement between both methods (area under the curve, 0.96; 95% confidence interval 0.93-0.99). The RLKPC decreased in 6/15 (40%) and 7/12 (58.3%) patients on days 14 and 30, respectively. Persistent eradication was observed in 2/12 (16.7%), 3/9 (33.3%), 4/8 (50%) and 7/8 (87.5%) patients at 1, 3, 6 and 12 months, respectively, with a median time of 150 days (range 30-270) to persistent eradication. Gentamicin-resistant KPC-Kp isolates were identified in 4/15 (26.7%) patients. The rates of infections (57.1% vs. 12.5%, P = 0.119) and deaths (71.4% vs. 0%, P = 0.007) were higher among patients with high baseline RLKPC. Following SDD, a rapid reduction on intestinal load is observed when the colonising KPC-Kp isolate is susceptible to gentamicin; however, persistent eradication at the end of SDD is low. Intestinal carriage of KPC-Kp persists after three months in about one third of patients.
PB Science Direct
YR 2022
FD 2022-04-17
LK http://hdl.handle.net/10668/22308
UL http://hdl.handle.net/10668/22308
LA en
NO Pérez-Nadales E, Natera AM, Recio-Rufíán M, Guzmán-Puche J, Cano Á, Frutos-Adame A, et al. Proof‑of‑concept study to quantify changes in intestinal loads of KPC-producing Klebsiella pneumoniae in colonised patients following selective digestive decontamination with oral gentamicin. J Glob Antimicrob Resist. 2022 Sep;30:16-22
DS RISalud
RD Apr 15, 2025