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A Randomized, Double-Blind, Placebo-Controlled Trial of Selective Digestive Decontamination Using Oral Gentamicin and Oral Polymyxin E for Eradication of Carbapenem-Resistant Klebsiella pneumoniae Carriage

  • Lisa Saidel-Odes (a1) (a2), Hana Polachek (a3), Nehama Peled (a4), Klaris Riesenberg (a1), Francisc Schlaeffer (a1), Yafa Trabelsi (a2), Seada Eskira (a5), Baha Yousef (a2), Rozalia Smolykov (a1), Shlomi Codish (a6) and Abraham Borer (a5)...
Abstract
Objective.

To assess the effectiveness of selective digestive decontamination (SDD) for eradicating carbapenem-resistant Klebsiella pneumoniae (CRKP) oropharyngeal and gastrointestinal carriage.

Design.

A randomized, double-blind, placebo-controlled trial with 7 weeks of follow-up per patient.

Setting.

A 1,000-bed tertiary-care university hospital.

Patients.

Adults with CRKP-positive rectal swab cultures.

Methods.

Patients were blindly randomized (1:1) over a 20-month period. The SDD arm received oral gentamicin and polymyxin E gel (0.5 g 4 times per day) and oral solutions of gentamicin (80 mg 4 times per day) and polymyxin E (1 × 106 units 4 times per day for 7 days). The placebo arm received oral placebo gel 4 times per day and 2 placebo oral solutions 4 times per day for 7 days. Strict contact precautions were applied. Samples obtained from the throat, groin, and urine were also cultured.

Results.

Forty patients (mean age ± standard deviation, 71 ± 16 years; 65% male) were included. At screening, greater than or equal to 30% of oropharyngeal, greater than or equal to 60% of skin, and greater than or equal to 35% of urine cultures yielded CRKP isolates. All throat cultures became negative in the SDD arm after 3 days (P< .0001). The percentages of rectal cultures that were positive for CRKP were significandy reduced at 2 weeks. At that time, 16.1% of rectal cultures in the placebo arm and 61.1% in the SDD arm were negative (odds ratio, 0.13; 95% confidence interval, 0.02–0.74; P<.0016). A difference between the percentages in the 2 arms was still maintained at 6 weeks (33.3% vs 58.5%). Groin colonization prevalence did not change in either arm, and the prevalence of urine colonization increased in the placebo arm.

Conclusions.

This SDD regimen could be a suitable decolonization therapy for selected patients colonized with CRKP, such as transplant recipients or immunocompromised patients pending chemotherapy and patients who require major intestinal or oropharyngeal surgery. Moreover, in outbreaks caused by CRKP infections that are uncontrolled by routine infection control measures, SDD could provide additional infection containment.

Infect Control Hosp Epidemiol 2012;33(1):14-19

Copyright
Corresponding author
Infectious Diseases Institute, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel (saidelod@bgu.ac.il)
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7. MJ Schwaber , S Klarfeld-Lidji , S Navon-Venezia , D Schwartz , A Leavitt , Y Carmeli . Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:10281033.

8. L Silvestri , S Kerr , A Gullo . Prevention of infection using selective decontamination of the digestive tract. In: HKF van Saene , L Silvestri , MA de la Cal , eds. Infection Control in the Intensive Care Unit. 2nd ed. Milan: Springer, 2005:297312.

9. R D'Amico , S Pifferi , C Leonetti , V Torri , A Tinazzi , A Liberati . Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ 1998;316:12751285.

11. C Ulrich , JE Harinck-de Weerd , NC Bakker , K Jacz , L Doornbos , VA de Ridder . Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989;15:424431.

12. LA Rocha , MJ Martin , S Pita , et al. Prevention of nosocomial infections in critically ill patients by selective decontamination of the digestive tract: a randomized, double blind, placebo-controlled study. Intensive Care Med 1992;18:398404.

14. AB Nathens , JC Marshall . Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Arch Surg 1999;134:170176.

15. EA Oostdijk , AM de Smet , J Kesecioglu , et al. The role of intestinal colonization with gram-negative bacteria as a source for intensive care unit-acquired bacteremia. Crit Care Med 2011;39:961966.

16. E de Jonge , MJ Schultz , L Spanjaard , et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003;362:10111016.

17. AM de Smet , JA Kluytmans , BS Cooper , et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009;360:2031.

18. C Brun-Buisson , P Legrand , A Rauss , et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med 1989;110:873881.

19. ME Taylor , BA Oppenheim . Selective decontamination of the gastrointestinal tract as an infection control measure. J Hosp Infect 1991;17:271278.

20. JM Hammond , PD Potgieter , GL Saunders , AA Forder . Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet 1992;340:59.

21. C Hebert , A Robicsek . Decolonization therapy in infection control. Curr Opin Infect Dis 2010;23:340345.

23. KF Anderson , DR Lonsway , JK Rasheed , et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenase in Enterobactereaceae. J Clin Microbiol 2007;45:27232725.

25. A Borer , J Gilad , N Porat , et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect 2007;67:149155.

26. MO Vernon , MK Hayden , WE Trick , RA Hayes , DW Blom , RA Weinstein . The effectiveness of source control to reduce the bioburden of vancomicin-resistant Enterococci. Arch Intern Med 2006;166:306312.

27. T Zuckerman , N Benyamini , H Sprecher , et al. SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state. Bone Marrow Transplant 2011;46:11261130.

28. NJ Reilly , AJ Nunn , K Pollock . Selective decontamination of the digestive tract: the role of the pharmacist. In: HKF van Saene , L Silvestri , MA de la Cal , eds. Infection Control in the Intensive Care Unit. 2nd ed. Milan: Springer, 2005:575592.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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