Oral gentamicin gut decontamination for prevention of KPC-producing Klebsiella pneumoniae infections: relevance of concomitant systemic antibiotic therapy
Carlo Tascini, Francesco Sbrana, Sarah Flammini, Enrico Tagliaferri, Fabio Arena, Alessandro Leonildi, Ilaria Ciullo, Francesco Amadori, Antonello Di Paolo, Andrea Ripoli, Russell Lewis, Gian Maria Rossolini, Francesco Menichetti, GENGUT Study Group, Paola Lambelet, Francesco Forfori, Bruno Viaggi, Francesca Papini, Lucio Urbani, Paolo Malacarne, Carlo Tascini, Francesco Sbrana, Sarah Flammini, Enrico Tagliaferri, Fabio Arena, Alessandro Leonildi, Ilaria Ciullo, Francesco Amadori, Antonello Di Paolo, Andrea Ripoli, Russell Lewis, Gian Maria Rossolini, Francesco Menichetti, GENGUT Study Group, Paola Lambelet, Francesco Forfori, Bruno Viaggi, Francesca Papini, Lucio Urbani, Paolo Malacarne
Abstract
Gut colonization represents the main source for KPC-producing Klebsiella pneumoniae (KPC-Kp) epidemic dissemination. Oral gentamicin, 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin-susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer. The overall decontamination rate was 68% (34/50). The median duration of gentamicin treatment was 9 days (interquartile range, 7 to 15 days) in decontaminated patients compared to 24 days (interquartile range, 20 to 30 days) in those with persistent colonization (P<0.001). In the six-month period of follow-up, KPC-Kp infections were documented in 5/34 (15%) successfully decontaminated patients compared to 12/16 (73%) persistent carriers (P<0.001). The decontamination rate was 96% (22/23) in patients receiving oral gentamicin only, compared to 44% (12/27) of those treated with oral gentamicin and concomitant systemic antibiotic therapy (CSAT) (P<0.001). The multivariate analysis confirmed CSAT and KPC-Kp infection as the variables associated with gut decontamination. In the follow-up period, KPC-Kp infections were documented in 2/23 (9%) of patients treated with oral gentamicin only and in 15/27 (56%) of those also receiving CSAT (P=0.003). No difference in overall death rate between different groups was documented. Gentamicin-resistant KPC-Kp strains were isolated from stools of 4/16 persistent carriers. Peak gentamicin blood levels were below 1 mg/liter in 12/14 tested patients. Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin-resistant KPC-Kp should be considered.
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Source: PubMed