Patient-Level Interventions to Prevent the Acquisition of Resistant Gram-Negative Bacteria in Critically Ill Patients: A Systematic Review

Zaky, Ahmed; Zeliadt, Steve

doi:10.1177/0310057x1504300105

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…It should be pointed out that the evaluation of the impact of antibiotics on in critically ill patients microbiota is highly complex because of the heterogeneity of dosing regimens, the co-administration of other antibiotics and other drugs that may also impact on its diversity. Therefore, to reduce the colonisation pressure, in addition to minimising exposure to antibiotics, it is essential to apply measures that have been shown to reduce colonisation from other patients or from colonised environmental surfaces; these measures include handwashing surveillance programs, adequate cleaning of patients, and the use of diverse strategies to minimise surface contamination [28, 29].…”

Section: Discussionmentioning

confidence: 99%

Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

Ruiz-Ramos

Gordón

Villarreal

et al. 2019

Antimicrob Resist Infect Control

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Background The aim of this study is to evaluate the risk factors for colonisation by multidrug resistant (MDR) K. pneumoniae in a critical care unit and the relationship between colonisation and the antibiotic pressure exerted by the antimicrobial treatments received by patients. Methods A prospective observational was designed. Patients admitted for more than 48 h to an intensive care unit were included. Samples for surveillance cultures were obtained from all the patients upon admission and once a week. The association between risk factors and colonisation by MDR K. pneumoniae was determined by logistic regression. A Cox regression model was used to evaluate the effect of the use of antimicrobials on the colonisation rate. An ARMIA model was used to investigate the association between the incidence of colonisation by MDR strains and the global consumption of antimicrobials in the unit. Results One thousand seven hundred twenty-five patients were included, from which 308 (17.9%) were positive for MDR K. pneumoniae . In the multivariate analysis, hospitalisation for longer than 7 days together with respiratory infection and administration of any antibiotic was associated with increased MR K. pneumoniae colonisation. Patients who received antibiotics for more than 48 h were colonised earlier than patients who did not receive antibiotic treatment [HR: 2.16 (95%CI:1.55–3.03)]. The ARIMA model found a significant association between the monthly colonisation rate for MR K. pneumoniae and the consumption of cephalosporins and carbapenems in the previous month. Conclusion Individual antibiotic administration and the global antibiotic pressure of cephalosporins and carbapenems are associated to an increased colonisation by MDR K. pneumoniae strains.

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Section: Discussionmentioning

confidence: 99%

Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

Ruiz-Ramos

Gordón

Villarreal

et al. 2019

Antimicrob Resist Infect Control

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“…Small trials found benefits from probiotic colonisation by multidrug-resistant Gram-negative organisms in critically ill patients 16 and by vancomycin-resistant enterococci (VRE) in renal dialysis patients. 17 A Cochrane review 18 of probiotics to prevent acute upper respiratory tract infections (URTIs) included 13 RCTs, 10 of which were meta-analysed (including a total of 3720 participants).…”

Section: Existing Trials and The Research Gapmentioning

confidence: 99%

Probiotics to reduce antibiotic administration in care home residents aged 65 years and older: the PRINCESS RCT

et al. 2021

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Background Care homes are an increasingly important sector of care. Care home residents are particularly vulnerable to infections and are often prescribed antibiotics, driving antibiotic resistance. Probiotics may be a cheap and safe way to reduce antibiotic use. Efficacy and possible mechanisms of action are yet to be rigorously evaluated in this group. Objective The objective was to evaluate efficacy and explore mechanisms of action of a daily oral probiotic combination in reducing antibiotic use and infections in care home residents. Design This was a multicentre, parallel, individually randomised, placebo-controlled, double-blind trial, with qualitative evaluation and mechanistic studies. Setting A total of 310 care home residents were randomised from 23 UK care homes (from December 2016 to May 2018). Participants The participants were care home residents aged ≥ 65 years who were willing and able to give informed consent or, if they lacked capacity to consent, had a consultee to advise about participation on their behalf. Intervention A daily capsule containing an oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 (n = 155) or matched placebo (n = 155) for up to 1 year. Main outcome measures The primary outcome was cumulative systemic antibiotic administration days for all-cause infections. Secondary outcomes included incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations and the detection of resistant Enterobacterales cultured from stool samples (not exclusively). Methods Participants were randomised (1 : 1) to receive capsules containing probiotic or matched placebo. Minimisation was implemented for recruiting care home and care home resident sex. Care home residents were followed up for 12 months with a review by a research nurse at 3 months and at 6–12 months post randomisation. Care home residents, consultees, care home staff and all members of the trial team, including assessors and statisticians, were blinded to group allocation. Results Care home residents who were randomised to probiotic had a mean 12.9 cumulative systemic antibiotic administration days (standard error 1.49 days) (n = 152) and care home residents randomised to placebo had a mean 12.0 cumulative systemic antibiotic administration days (standard error 1.50 days) (n = 153) (adjusted incidence rate ratio = 1.13, 95% confidence interval 0.79 to 1.63; p = 0.495). There was no evidence of any beneficial effects on incidence and duration of infections, antibiotic-associated diarrhoea, quality of life, hospitalisations, the detection of resistant Enterobacterales cultured from stool samples or other secondary outcomes. There was no evidence that this probiotic combination improved blood immune cell numbers, subtypes or responses to seasonal influenza vaccination. Conclusions Care home residents did not benefit from daily consumption of a combination of the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 to reduce antibiotic consumption. Limitations Limitations included the following: truncated follow-up of some participants; higher than expected probiotics in stool samples at baseline; fewer events than expected meant that study power may have been lower than anticipated; standard infection-related definitions were not used; and findings are not necessarily generalisable because effects may be strain specific and could vary according to patient population. Future work Future work could involve further rigorous efficacy, mechanisms and effectiveness trials of other probiotics in other population groups and settings regarding antibiotic use and susceptibility to and recovery from infections, in which potential harms should be carefully studied. Trial registration Current Controlled Trials ISRCTN16392920. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.

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“…Meta-analysis indicates that probiotics can reduce antibiotic-associated diarrhoea (AAD), but more research is needed to determine which probiotics are associated with greatest efficacy and for which patients receiving which specific antibiotics 15. Probiotics may also reduce AMR colonisation,14 which could be important as most UTIs arise from autoinoculation with gut organisms.…”

Section: Introductionmentioning

confidence: 99%

“…They may prevent infection by blocking pathogenic colonisation and enhancing gut-immune interaction, with influence on mucosal and systemic immunity, leading to enhanced natural killer cell activity and vaccine response11 in older people 12 13. A systematic review and meta-analysis found that probiotics reduced the risk of upper respiratory tract infections (URTIs) and reduced antibiotic prescribing in adults and that side effects were minor 14. However, the review noted poor allocation concealment in several studies and heterogeneity in findings and recommended that future randomised controlled trials (RCTs) should ‘focus on older people’.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a double-blind placebo-controlled trial to evaluate the efficacy of probiotics in reducing antibiotics for infection in care home residents: the Probiotics to Reduce Infections iN CarE home reSidentS (PRINCESS) trial

et al. 2019

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IntroductionCare home residents are at increased risk of infections and antibiotic prescription. Reduced antibiotic use from fewer infections would improve quality of life. TheProbiotics toReduceInfections iN CarEhome reSidentS(PRINCESS) trial aims to determine the efficacy and investigate mechanisms of daily probiotics on antibiotic use and incidence of infections in care home residents.Methods and analysisPRINCESS is a double-blind, individually randomised, placebo-controlled trial that will assess the effect of a daily oral probiotic combination ofLactobacillus rhamnosus,GG (LGG) andBifidobacterium animalissubsp.lactis, BB-12 (BB-12) on cumulative antibiotic administration days (CAADs) (primary outcome) for infection in up to 330 care home residents aged ≥65 years over up to 12 months. Secondary outcomes include:Infection:Total number of days of antibiotic administration for each infection type (respiratory tract infection, urinary tract infection, gastrointestinal infection, unexplained fever and other); number, site, duration of infection; estimation of incidence and duration of diarrhoea and antibiotic-associated diarrhoea;Stool microbiology:Clostridium difficileinfection; Gram-negative Enterobacteriaceae and vancomycin-resistant enterococci; LGG and BB-12.Oral microbiology: Candidaspp.Health and well-being:Self and/or proxy health-related quality of life EQ5D (5 L); self-and/or proxy-reported ICEpop CAPability measure for older people.Hospitalisations:number and duration of all-cause hospital stays.Mortality:deaths.Mechanistic immunology outcomes:influenza vaccine efficacy (haemagglutination inhibition assay and antibody titres); full blood count and immune cell phenotypes, plasma cytokines and chemokines; cytokine and chemokine response in whole blood stimulatedex vivoby toll-like receptor 2 and 4 agonists; monocyte and neutrophil phagocytosis ofEscherichia coli; serum vitamin D.Ethics and disseminationEthics approval is from the Wales Research Ethics Committee 3. Findings will be disseminated through peer-reviewed journals and conferences; results will be of interest to patient and policy stakeholders.Trial registration numberISRCTN16392920; Pre-results.

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Patient-Level Interventions to Prevent the Acquisition of Resistant Gram-Negative Bacteria in Critically Ill Patients: A Systematic Review

Cited by 9 publications

References 36 publications

Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

Probiotics to reduce antibiotic administration in care home residents aged 65 years and older: the PRINCESS RCT

Protocol for a double-blind placebo-controlled trial to evaluate the efficacy of probiotics in reducing antibiotics for infection in care home residents: the Probiotics to Reduce Infections iN CarE home reSidentS (PRINCESS) trial

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