Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria With Oral Colistin in Patients With Hematological Malignancies: Results of a Randomized Controlled Trial

Abstract

BackgroundIntestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies.ObjectivesThe objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies.MethodsIn a tertiary hematology center, adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457.ResultsShort-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17–9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs. 12.9%), but overall in the 90-day observation period, it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed.ConclusionsThis study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects.

Anticolonization of Carbapenem-Resistant Klebsiella pneumoniae by Lactobacillus plantarum LP1812 Through Accumulated Acetic Acid in Mice Intestinal

“…Numerous decolonization studies have been undertaken, including selective digestive decontamination with colistin or aminoglycosides ( Machuca et al., 2016 ; Stoma et al., 2018 ), custom-made bacteriophage ( Hua et al., 2017 ; Corbellino et al., 2020 ; Liu et al., 2021 ) and fecal microbiota transplantation (FMT) ( Alagna et al., 2020 ; Gouveia et al., 2020 ; Ueckermann, et al., 2020 ). Although those methods demonstrated some decolonization effects, the possibility of drug resistance induced by gentamycin or colistin, the high cost and prolonged waiting time for phage, and the possibility of infectious agent transmission accompanied by FMT rendered them impractical for generalization.…”

Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients

“…Studies of selective digestive decontamination have shown limited short-term effectiveness in suppression of resistant organisms. [139][140][141][142][143] However, using oral antibiotics for decolonization is not routinely recommended because of the transient nature of these effects and concerns related to the emergence of resistance to the agents used for decolonization and detrimental consequences to the gut microbiome. 144 Fecal microbiota transplantation is another emerging strategy that could suppress colonization with resistant bacteria.…”

“…Theoretically, identifying colonization with a resistant gut organism could allow for decolonization to prevent translocation of bacteria into the bloodstream during neutropenia. Studies of selective digestive decontamination have shown limited short‐term effectiveness in suppression of resistant organisms 139–143 . However, using oral antibiotics for decolonization is not routinely recommended because of the transient nature of these effects and concerns related to the emergence of resistance to the agents used for decolonization and detrimental consequences to the gut microbiome 144 .…”