Oral Gentamicin Gut Decontamination for Prevention of KPC-Producing Klebsiella pneumoniae Infections: Relevance of Concomitant Systemic Antibiotic Therapy

Tascini, Carlo; Sbrana, Francesco; Flammini, Sarah; Tagliaferri, Enrico; Arena, Fabio; Leonildi, Alessandro; Ciullo, Ilaria; Amadori, Francesco; Paolo, Antonello Di; Ripoli, Andrea; Lewis, Russell E.; Rossolini, Gian María; Menichetti, Francesco

doi:10.1128/aac.02283-13

Cited by 62 publications

(47 citation statements)

References 21 publications

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“…For this purpose, oral gentamycin or a combination of oral gentamycin and colistin were used, with eradication rate of 40-50%, which was higher than the spontaneous eradication rate, but tended to decrease after few weeks. [117][118][119] The efficacy of decolonization was significantly lower in case of concomitant administration of systemic antibiotic therapy, which is frequently the case in cancer population. 117 The main drawback of decolonization is the possibility of inducing or selecting resistance to the last antibiotics which could be administered in case of the MDR infection.…”

Section: Othersmentioning

confidence: 99%

“…[117][118][119] The efficacy of decolonization was significantly lower in case of concomitant administration of systemic antibiotic therapy, which is frequently the case in cancer population. 117 The main drawback of decolonization is the possibility of inducing or selecting resistance to the last antibiotics which could be administered in case of the MDR infection. In fact, in 2 of the studies the rate of post-decolonization resistance was 25% and 45% to gentamycin and 40% to colistin.…”

Section: Othersmentioning

confidence: 99%

“…In fact, in 2 of the studies the rate of post-decolonization resistance was 25% and 45% to gentamycin and 40% to colistin. 117,118 Finally, digestive decontamination is not applicable to patients colonized in organs other than gastrointestinal tract. Unless we have more data in neutropenic subjects, or novel therapeutic options are available, decolonization will remain a controversial procedure to be carefully considered for selected patients.…”

Section: Othersmentioning

confidence: 99%

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Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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Section: Othersmentioning

confidence: 99%

Section: Othersmentioning

confidence: 99%

Section: Othersmentioning

confidence: 99%

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Bloodstream infections in neutropenic cancer patients: A practical update

2016

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“…In the pre-transplant setting, small studies evaluating the role of selective digestive decontamination (SDD) with oral gentamicin with or without oral colistin have demonstrated a significant decline in CRKP carriage rates. 96,97 However, this strategy was not effective in preventing CRKP infections in HSCT recipients 98 and has also been associated with the development of colistin and gentamicin resistance. 97,99 The development of resistance to some of the only treatment options for CRE infections is a major concern and thus the use of SDD prior to SOT or HSCT cannot be routinely recommended.…”

Section: Prevention Of Cre Infection In Transplant and Hematologic Onmentioning

confidence: 99%

“…96,97 However, this strategy was not effective in preventing CRKP infections in HSCT recipients 98 and has also been associated with the development of colistin and gentamicin resistance. 97,99 The development of resistance to some of the only treatment options for CRE infections is a major concern and thus the use of SDD prior to SOT or HSCT cannot be routinely recommended. 46 Another strategy to consider in patients who are colonized with CRE and undergoing SOT is to administer peri-operative CREactive prophylaxis.…”

Section: Prevention Of Cre Infection In Transplant and Hematologic Onmentioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

2016

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Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.

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Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

Howard‐Anderson¹,

Pouch²

2020

Emerging Transplant Infections

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The incidence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) and carbapenem-resistant Enterobacterales (CRE) infections has been increasing worldwide, although the prevalence and mechanism of resistance vary by geographic region and institutional patterns of resistance. These multidrug-resistant infections are challenging to diagnose and treat and can cause significant morbidity and mortality in transplant patients. In this chapter we highlight recent trends in epidemiology, including risk factors for acquiring ESBL-EB and CRE, clinical outcomes, and new strategies for

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Oral Gentamicin Gut Decontamination for Prevention of KPC-Producing Klebsiella pneumoniae Infections: Relevance of Concomitant Systemic Antibiotic Therapy

Cited by 62 publications

References 21 publications

Bloodstream infections in neutropenic cancer patients: A practical update

Bloodstream infections in neutropenic cancer patients: A practical update

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

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