Drug regimen may eliminate colonization with superbug CRE

Orally administered, nonabsorbable antibiotics were effective in eradicating carbapenem-resistant Enterobacteriaceae (CRE) colonization, according to a new study published in the December issue of the American Journal of Infection Control

Lloyd Dunlap
WASHINGTON, D.C.—Orally administered, nonabsorbable antibiotics were effective in eradicating carbapenem-resistant Enterobacteriaceae (CRE) colonization, according to a new study published in the December issue of the American Journal of Infection Control, a publication of the Association for Professionals in Infection Control and Epidemiology (APIC).
 
Carbapenem-resistant enterobacteriaceae (CRE) is a family of gram-negative bacteria that are nearly immune to the carbapenem class of antibiotics, considered the drug of last resort for such infections. The bacteria kill up to half of patients getting bloodstream infections from them. Death rates of up to 50 percent have been reported in patients with CRE sepsis, a rate much higher than other resistant infections such as MRSA or Clostridium difficile.
 
According to the Centers for Disease Control, CRE was first detected in a North Carolina hospital in 2001. Since that time, it has been identified in health care facilities in 41 other states.
 
Researchers at Rambam Health Care Campus, a 1,000-bed, tertiary care center in Haifa, Israel, examined isolates from 152 patients who were identified as CRE carriers (colonized with the organism, but not yet showing disease) over a 24-month period. There were 50 patients in the treatment group, who received one of three drug regimens based on antibiotic sensitivities of their isolates: nonabsorbable gentamicin (26), colistin (16), or a combination of the two (8). Patients received treatment until cultures were negative for CRE, or for a maximum of 60 days.
 
Patients not sensitive to either antibiotic, or those who did not give consent (102), comprised the control group and were also followed (median=140 days) in order to determine the spontaneous eradication rate.
 
CRE was eradicated in 42 percent of patients taking gentamicin (11/26), 50 percent taking colistin (8/16), and 37.5 percent taking a combined treatment (3/8), for an overall eradication rate for patients on all treatment regimens of 44 percent (22/50). This compares to a 7 percent (7/102) eradication rate in the control group.
In patients where colonization was stamped out, regardless of whether they received treatment, there were fewer deaths than in those where colonization persisted (17 percent vs. 49 percent, respectively).
 
“Treatment with oral nonabsorbable antibiotics, to which CRE is susceptible, appears to be safe and effective for eradication of the CRE carrier state,” say the researchers in the study. “Reducing the reservoir of CRE carriers in healthcare facilities may thereby reduce patient-to-patient transmission and the incidence of clinical infection with this difficult-to-treat organism. When mortality rate in patients who had successful eradication of the carrier state (either spontaneous or on treatment) was compared with that of patients failing eradication, significantly lower mortality was found in the former group. This could point toward a real reduction of mortality attributed to the eradication of CRE carrier state.”
 
According to the U.S. Centers for Disease Control and Prevention (CDC), untreatable and hard-to-treat infections from CRE are on the rise among patients in medical facilities. These bacteria have become resistant to nearly all the antibiotics currently available and can transfer their resistance to other organisms. According to the CDC, almost half of patients who get bloodstream infections from CRE germs die from the infections.
 
AJIC: American Journal of Infection Control (www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.
 
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization.
 
Eradication of carbapenem-resistant Enterobacteriaceae gastrointestinal colonization with nonabsorbable oral antibiotic treatment: A prospective controlled trial,” by Ilana Oren, Hannah Sprecher, Renato Finkelstein, Salim Hadad, Ami Neuberger, Keatam Hussein, Ayelet Raz-Pasteur, Noa Lavi, Elias Saad, Israel Henig, Netanel Horowitz, Irit Avivi, Noam Benyamini, Riva Fineman, Yishai Ofran, Nuhad Haddad, Jacob M. Rowe and Tsila Zuckerman appears in the American Journal of Infection Control, Volume 41, Issue 12 (December 2013).
 

Lloyd Dunlap

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