RT Journal Article
T1 Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing Klebsiella pneumoniae
A1 Machuca, Isabel
A1 Gutierrez-Gutierrez, Belen
A1 Perez Cortes, Salvador
A1 Gracia-Ahufinger, Irene
A1 Serrano, Josefina
A1 Dolores Madrigal, Maria
A1 Barcala, Jose
A1 Rodriguez-Lopez, Fernando
A1 Rodriguez-Bano, Jesus
A1 Torre-Cisneros, Julian
K1 Carbapenem-resistant
K1 Enterobacteriaceae
K1 Gentamicin
K1 Predictors
K1 Sepsis
K1 Impact
K1 Área de Gestión Sanitaria de Jerez, Costa Noroeste y Sierra de Cádiz
AB Invasive infections caused by KPC-producing Klebsiella pneumoniae (KPCKP) are associated with very high mortality. Because infection is usually preceded by rectal colonization, we investigated if decolonization therapy (DT) with aminoglycosides had a protective effect in selected patients.Patients with rectal colonization by colistin-resistant KPCKP who were at high risk of developing infection (because of neutropenia, surgery, previous recurrent KPCKP infections or multiple comorbidities) were followed for 180 days. Cox regression analysis including a propensity score was used to investigate the impact of the use of two intestinal decolonization regimens with oral aminoglycosides (gentamicin and neomycin/streptomycin) on mortality, risk of KPCKP infections and microbiological success. The study was registered with ClinicalTrials.gov (NCT02604849).The study sample comprised 77 colonized patients, of which 44 (57.1%) received DT. At 180 days of follow-up, decolonization was associated with a lower risk of mortality in multivariate analyses (HR 0.18; 95% CI 0.06-0.55) and a lower risk of KPCKP infections (HR 0.14; 95% CI 0.02-0.83) and increased microbiological success (HR 4.06; 95% CI 1.06-15.6). Specifically, gentamicin oral therapy was associated with a lower risk of crude mortality (HR 0.15; 95% CI 0.04-0.54), a lower risk of KPCKP infections (HR 0.86; 95% CI 0.008-0.94) and increased microbiological response at 180 days of follow-up (HR 5.67; 95% CI 1.33-24.1). Neomycin/streptomycin therapy was only associated with a lower risk of crude mortality (HR 0.22; 95% CI 0.06-0.9).Intestinal decolonization with aminoglycosides is associated with a reduction in crude mortality and KPCKP infections at 180 days after initiating treatment.
PB Oxford University Press
SN 0305-7453
YR 2016
FD 2016-06-02
LK http://hdl.handle.net/10668/18956
UL http://hdl.handle.net/10668/18956
LA en
NO Machuca I, Gutiérrez-Gutiérrez B, Pérez Cortés S, Gracia-Ahufinger I, Serrano J, Madrigal MD, et al. Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing Klebsiella pneumoniae. J Antimicrob Chemother. 2016 Nov;71(11):3242-3249
DS RISalud
RD Apr 12, 2025