Is Selective Digestive Decontamination Useful in Controlling Aerobic Gram-Negative Bacilli Producing Extended Spectrum Beta-Lactamases?

Abecasis, Francisco; Sarginson, R. E.; Kerr, Steve; Taylor, Nia; Saene, H. K. F. van

doi:10.1089/mdr.2010.0060

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…However, as patients were not followed up, this reflects end of treatment efficacy, and no sustained effects were reported [ 13 ]. The same holds true for the studies of Abecassis et al and of Troché et al with ESBL-E clearance under SDD regimens of 54 and 46 % respectively [ 14 , 15 ].…”

Section: Resultssupporting

confidence: 65%

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

et al. 2015

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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.

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Section: Resultssupporting

confidence: 65%

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

et al. 2015

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“…Abecasis et al (18), for example, have claimed that selective digestive decontamination by the use of parenteral cefotaxime and enteral polymyxin E-tobramycin in children was effective in controlling ESBL-producing aerobic Gram-negative bacilli and could avoid outbreaks of carriage or infection, yet other teams have sometimes reported contrary results, and the selective decontamination method raises many concerns in hospitals because of the use of antimicrobials of last resort, such as colistin (19,20). Furthermore, this method is obviously unacceptable for animals.…”

Section: Discussionmentioning

confidence: 99%

Escherichia coli Probiotic Strain ED1a in Pigs Has a Limited Impact on the Gut Carriage of Extended-Spectrum-β-Lactamase-Producing E. coli

Mourand

Paboeuf

Fleury

et al. 2017

Antimicrob Agents Chemother

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Four trials were conducted to evaluate the impact of Escherichia coli probiotic strain ED1a administration to pigs on the gut carriage or survival in manure of extended-spectrum-␤-lactamase-producing E. coli. Groups of pigs were orally inoculated with strain E. coli M63 carrying the bla CTX-M-1 gene (n ϭ 84) or used as a control (n ϭ 26). In the first two trials, 24 of 40 E. coli M63-inoculated pigs were given E. coli ED1a orally for 6 days starting 8 days after oral inoculation. In the third trial, 10 E. coli M63-inoculated pigs were given either E. coli ED1a or probiotic E. coli Nissle 1917 for 5 days. In the fourth trial, E. coli ED1a was given to a sow and its 12 piglets, and these 12 piglets plus 12 piglets that had not received E. coli ED1a were then inoculated with E. coli M63. Fecal shedding of cefotaxime-resistant Enterobacteriaceae (CTX-RE) was studied by culture, and bla CTX-M-1 genes were quantified by PCR. The persistence of CTX-RE in manure samples from inoculated pigs or manure samples inoculated in vitro with E. coli M63 with or without probiotics was studied. The results showed that E. coli M63 and ED1a were good gut colonizers. The reduction in the level of fecal excretion of CTX-RE in E. coli ED1a-treated pigs compared to that in nontreated pigs was usually less than 1 log 10 CFU and was mainly observed during the probiotic administration period. The results obtained with E. coli Nissle 1917 did not differ significantly from those obtained with E. coli ED1a. CTX-RE survival did not differ significantly in manure samples with or without probiotic treatment. In conclusion, under our experimental conditions, E. coli ED1a and E. coli Nissle 1917 could not durably prevent CTX-RE colonization of the pig gut.

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“…An intense debate is ongoing between the supporters and the opponents to this approach. The authors did not report any ESBL outbreaks; SDD was effective in reducing colonization with ESBL in patients colonized with tobramycinsensitive organisms but not in patients with tobramycin resistance (59%) [44]. In children, the evidence is scanty and SOD and SDD have not been extensively used.…”

Section: Selective and Oral Digestive Tract Decontaminationmentioning

confidence: 96%

Decolonization and decontamination

Vergnano

2015

Current Opinion in Infectious Diseases

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Is Selective Digestive Decontamination Useful in Controlling Aerobic Gram-Negative Bacilli Producing Extended Spectrum Beta-Lactamases?

Abstract: SDD is an effective measure to control AGNB-ESBL and to avoid outbreak episodes of either carriage or infection. When tobramycin resistance is found, replacing it with another aminoglycoside based on antibiogram may be more effective in achieving AGNB clearance.

Cited by 22 publications

References 32 publications

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

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

Escherichia coli Probiotic Strain ED1a in Pigs Has a Limited Impact on the Gut Carriage of Extended-Spectrum-β-Lactamase-Producing E. coli

Decolonization and decontamination

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