title: Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing Klebsiella pneumoniae.
abstract: Invasive infections caused by KPC-producing Klebsiella pneumoniae (KPCKP) are associated with very high mortality. Because infection is usually preceded by rectal colonization, we investigated if decolonization therapy (DT) with aminoglycosides had a protective effect in selected patients.
  
  
  
  Patients with rectal colonization by colistin-resistant KPCKP who were at high risk of developing infection (because of neutropenia, surgery, previous recurrent KPCKP infections or multiple comorbidities) were followed for 180 days. Cox regression analysis including a propensity score was used to investigate the impact of the use of two intestinal decolonization regimens with oral aminoglycosides (gentamicin and neomycin/streptomycin) on mortality, risk of KPCKP infections and microbiological success. The study was registered with ClinicalTrials.gov (NCT02604849).
  
  
  
  The study sample comprised 77 colonized patients, of which 44 (57.1%) received DT. At 180 days of follow-up, decolonization was associated with a lower risk of mortality in multivariate analyses (HR 0.18; 95% CI 0.06-0.55) and a lower risk of KPCKP infections (HR 0.14; 95% CI 0.02-0.83) and increased microbiological success (HR 4.06; 95% CI 1.06-15.6). Specifically, gentamicin oral therapy was associated with a lower risk of crude mortality (HR 0.15; 95% CI 0.04-0.54), a lower risk of KPCKP infections (HR 0.86; 95% CI 0.008-0.94) and increased microbiological response at 180 days of follow-up (HR 5.67; 95% CI 1.33-24.1). Neomycin/streptomycin therapy was only associated with a lower risk of crude mortality (HR 0.22; 95% CI 0.06-0.9).
  
  
  
  Intestinal decolonization with aminoglycosides is associated with a reduction in crude mortality and KPCKP infections at 180 days after initiating treatment.
authors: Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain.
authors: Isabel
authors: I
authors: Machuca
authors: Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena and Virgen del Rocío - IBiS, and Department of Medicine, Universidad de Sevilla, Sevilla, Spain.
authors: Belén
authors: B
authors: Gutiérrez-Gutiérrez
authors: Unit of Infectious Diseases, Hospital Universitario de Jerez, Cádiz, Spain.
authors: Salvador
authors: S
authors: Pérez Cortés
authors: Unit of Microbiology, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain.
authors: Irene
authors: I
authors: Gracia-Ahufinger
authors: Unit of Haematology, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain.
authors: Josefina
authors: J
authors: Serrano
authors: Unit of Haematology, Hospital Universitario de Jerez, Cádiz, Spain.
authors: María Dolores
authors: MD
authors: Madrigal
authors: Unit of Infectious Diseases, Hospital Universitario de Jerez, Cádiz, Spain.
authors: José
authors: J
authors: Barcala
authors: Unit of Microbiology, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain.
authors: Fernando
authors: F
authors: Rodríguez-López
authors: Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena and Virgen del Rocío - IBiS, and Department of Medicine, Universidad de Sevilla, Sevilla, Spain jesusrb@us.es.
authors: Jesús
authors: J
authors: Rodríguez-Baño
authors: Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain.
authors: Julián
authors: J
authors: Torre-Cisneros
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002353:Carrier State / Q000188:drug therapy; D003091:Colistin / Q000494:pharmacology; D003666:Decontamination / Q000379:methods*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; D003091:Colistin