Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience
| Autor: | Arne C. Rodloff, Petra Gastmeier, Sven Laudi, Axel Dürrbeck, Diana Becker-Rux, Christoph Lübbert, Udo X. Kaisers, Sarah Faucheux, Tim Eckmanns, Thilo Busch |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Time Factors Klebsiella pneumoniae Biology beta-Lactamases Disease Outbreaks Feces Antibiotic resistance Germany Internal medicine Drug Resistance Bacterial Selective digestive decontamination polycyclic compounds medicine Humans Pharmacology (medical) In patient Aged Retrospective Studies Aged 80 and over Cross Infection Infection Control Greece Colistin Outbreak General Medicine Middle Aged biochemical phenomena metabolism and nutrition bacterial infections and mycoses biology.organism_classification Anti-Bacterial Agents Klebsiella Infections Surgery Infectious Diseases KPC-2 producing Klebsiella pneumoniae Female Gentamicin Gentamicins medicine.drug |
| Zdroj: | International Journal of Antimicrobial Agents. 42:565-570 |
| ISSN: | 0924-8579 |
| DOI: | 10.1016/j.ijantimicag.2013.08.008 |
| Popis: | After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80 mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5 g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48 h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P = 0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development. |
| Databáze: | OpenAIRE |
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