Machuca, IsabelGutierrez-Gutierrez, BelenPerez Cortes, SalvadorGracia-Ahufinger, IreneSerrano, JosefinaDolores Madrigal, MariaBarcala, JoseRodriguez-Lopez, FernandoRodriguez-Bano, JesusTorre-Cisneros, Julian2023-02-122023-02-122016-06-02Machuca 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):3242-32490305-7453http://hdl.handle.net/10668/18956Invasive 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.enCarbapenem-resistantEnterobacteriaceaeGentamicinPredictorsSepsisImpactÁrea de Gestión Sanitaria de Jerez, Costa Noroeste y Sierra de CádizAminoglycosidesColistinNeomycinStreptomycinAnti-bacterial agentsNeutropeniaMultivariate analysisresearch articleopen accessAminoglicósidosAntibacterianosAnálisis multivarianteColistinaEstreptomicinaNeomicina10.1093/jac/dkw2721460-2091https://academic.oup.com/jac/article-pdf/71/11/3242/16863992/dkw272.pdf388005100031