Background
Carbapenem-resistant Enterobacteriaceae (CRE) are emerging. In attempt to eradicate CRE colonization, we conducted a semirandomized,
prospective, controlled trial using oral nonabsorbable antibiotics.
Methods
Consecutive hospitalized CRE carriers were studied. Patients whose rectal isolates
were gentamicin sensitive but colistin resistant were treated with gentamicin. Patients
whose isolates were colistin sensitive but gentamicin resistant were treated with
colistin. Patients whose isolates were sensitive to both drugs were randomized to
3 groups of oral antibiotic treatment: gentamicin, colistin, or both. Patients whose
isolates were resistant to both drugs, and those who did not consent, were followed
for spontaneous eradication.
Results
One hundred fifty-two patients were included; 102 were followed for spontaneous eradication
for a median duration of 140 days (controls), and 50 received 1 of the 3 drug regimens:
gentamicin, 26; colistin, 16; both drugs, 8, followed for a median duration of 33
days. Eradication rates in the 3 treatment groups were 42%, 50%, and 37.5%, respectively,
each significantly higher than the 7% spontaneous eradication rate in the control
group (P < .001, P < .001, and P = .004, respectively) with no difference between the regimens. No significant adverse
effects were observed.
Conclusion
Oral antibiotic treatment with nonabsorbable drugs to which CRE is susceptible appears
to be an effective and safe for eradication of CRE colonization and, thereby, may
reduce patient-to-patient transmission and incidence of clinical infection with this
difficult-to-treat organism.
Key Words
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Article info
Footnotes
Conflicts of interest: None to report.
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© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
