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

Abstract

BackgroundMultidrug-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.MethodsIn 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.ResultsFirst-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.ConclusionsAt 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.

In Vitro Activity of Neomycin, Streptomycin, Paromomycin and Apramycin against Carbapenem-Resistant Enterobacteriaceae Clinical Strains

“…Nonetheless, oral administration of neomycin has been used for inhibiting the overgrowth of gut microflora (Clark, 1977 ) and for decolonizing the intestinal carriage of extended-spectrum β-lactamase(ESBL)-producing Enterobacteriaceae (Huttner et al, 2013 ). Paromomycin has also been applied for decolonizing ESBL-producing Enterobacteriaceae (Buehlmann et al, 2011 ; Rieg et al, 2015 ). As both agents are not given by intravenous injection, they are unlikely to be used for treating systematic infections caused by CRE.…”

Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study

“…Rieg et al showed that treatment led to the eradication of ESBL+ Enterobacteriaceae in 42% of individuals. However, 54% of them were recolonized within 3 months [27]. A double-blind, placebo-controlled study showed that oral colistin Figure 1.…”

Fecal microbiota transplantation against intestinal colonization by extended spectrum beta-lactamase producing Enterobacteriaceae: a proof of principle study

“…Decolonization of ESBL-EB with antibiotic regiments may be achieved, but is often followed by recolonization [ 11 ]. In contrast, FMT may decolonize while preventing relapse and work in synergy with antibiotic regimens, as it does in the treatment of recurrent CDI [ 12 ].…”