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Colistin, gentamicin effective at eradicating gastrointestinal CRE colonization
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Treatment with nonabsorbable antibiotics, including colistin and gentamicin, was safe and effective at eradicating gastrointestinal colonization of carbapenem-resistant Enterobacteriaceae, according to data published in the American Journal of Infection Control.
Since 2006, major hospitals in Israel have observed a continuous increase in the number of carbapenem-resistant Enterobacteriaceae (CRE) isolates, according to Ilana Oren, MD, of the Infectious Disease Unit at Rambam Healthcare Campus in Haifa, Israel. Implementation of strict infection control measures did not succeed in controlling the outbreak, she said.
Ilana Oren
“In 2008, we noticed a sharp increase in CRE isolates, despite appropriate IV antibiotic therapy,” Oren told Infectious Disease News. “We hypothesized that continuous bacteremia could have been secondary to repeated bloodstream invasion by CRE from the reservoir in the gastrointestinal tract through mucosa damaged during severe mucositis. We attempted to eradicate this source of the CRE with oral gentamicin. The favorable results of the pilot study prompted us to conduct this partially randomized, prospective controlled trial.”
The study included 152 consecutive patients who presented during a 24-month period starting on June 1, 2009. They were screened for CRE using rectal swabs, and all were colonized with CRE isolates. Fifty patients who were susceptible to both colistin and gentamicin were randomly assigned to one of three treatments: gentamicin alone (n=26), colistin alone (n=16) or both (n=8). The remaining 102 patients served as a control group and were monitored for spontaneous eradication.
Seven patients in the control group had spontaneous eradication, a 7% eradication rate after a 140-day median follow-up. The eradication rate with gentamicin alone was 42%, after a median treatment time of 31 days. For colistin, the eradication rate was 50%, after a median treatment time of 54 days. The combination treatment had an eradication rate of 37.5%, after a 45-day median treatment time. For all treatments combined, the eradication rate was 44%, significantly higher than the spontaneous eradication rate. There were no significant adverse effects associated with any of the treatments.
“Reducing the reservoir of CRE carriers in health care facilities may thereby reduce patient-to-patient transmission and the incidence of clinical infection with this difficult-to-treat organism,” Oren said. “For now, we are using oral gentamicin and colistin for treatment of CRE carriers who develop CRE bacteremia, along with IV antibiotics.”
Disclosure: The researchers report no relevant financial disclosures.
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