title: Eradication of carbapenem-resistant Enterobacteriaceae gastrointestinal colonization with nonabsorbable oral antibiotic treatment: A prospective controlled trial.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: i_oren@rambam.health.gov.il.
authors.forename: Ilana
authors.initials: I
authors.lastname: Oren
authors.forename: Hannah
authors.initials: H
authors.lastname: Sprecher
authors.forename: Renato
authors.initials: R
authors.lastname: Finkelstein
authors.forename: Salim
authors.initials: S
authors.lastname: Hadad
authors.forename: Ami
authors.initials: A
authors.lastname: Neuberger
authors.forename: Keatam
authors.initials: K
authors.lastname: Hussein
authors.forename: Ayelet
authors.initials: A
authors.lastname: Raz-Pasteur
authors.forename: Noa
authors.initials: N
authors.lastname: Lavi
authors.forename: Elias
authors.initials: E
authors.lastname: Saad
authors.forename: Israel
authors.initials: I
authors.lastname: Henig
authors.forename: Netanel
authors.initials: N
authors.lastname: Horowitz
authors.forename: Irit
authors.initials: I
authors.lastname: Avivi
authors.forename: Noam
authors.initials: N
authors.lastname: Benyamini
authors.forename: Riva
authors.initials: R
authors.lastname: Fineman
authors.forename: Yishai
authors.initials: Y
authors.lastname: Ofran
authors.forename: Nuhad
authors.initials: N
authors.lastname: Haddad
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.forename: Tsila
authors.initials: T
authors.lastname: Zuckerman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002353:Carrier State / Q000188:drug therapy*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents
keywords: Colistin; Gentamicin; Rectal carriage; SDD