title: Oral gentamicin gut decontamination for prevention of KPC-producing Klebsiella pneumoniae infections: relevance of concomitant systemic antibiotic therapy.
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.
authors.affiliation: Infectious Diseases Unit, Cisanello Hospital, Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.forename: Francesco
authors.initials: F
authors.lastname: Sbrana
authors.forename: Sarah
authors.initials: S
authors.lastname: Flammini
authors.forename: Enrico
authors.initials: E
authors.lastname: Tagliaferri
authors.forename: Fabio
authors.initials: F
authors.lastname: Arena
authors.forename: Alessandro
authors.initials: A
authors.lastname: Leonildi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ciullo
authors.forename: Francesco
authors.initials: F
authors.lastname: Amadori
authors.forename: Antonello
authors.initials: A
authors.lastname: Di Paolo
authors.forename: Andrea
authors.initials: A
authors.lastname: Ripoli
authors.forename: Russell
authors.initials: R
authors.lastname: Lewis
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins