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Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial

BACKGROUND: Intestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies. OBJECTIVES: The objective of this study was to evaluate the efficacy of oral col...

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Autores principales: Stoma, Igor, Karpov, Igor, Iskrov, Igor, Krivenko, Svetlana, Uss, Anatoly, Vlasenkova, Svetlana, Lendina, Irina, Cherniak, Veronika, Suvorov, Dmitrii
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Università Cattolica del Sacro Cuore 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937973/
https://www.ncbi.nlm.nih.gov/pubmed/29755707
http://dx.doi.org/10.4084/MJHID.2018.030
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author Stoma, Igor
Karpov, Igor
Iskrov, Igor
Krivenko, Svetlana
Uss, Anatoly
Vlasenkova, Svetlana
Lendina, Irina
Cherniak, Veronika
Suvorov, Dmitrii
author_facet Stoma, Igor
Karpov, Igor
Iskrov, Igor
Krivenko, Svetlana
Uss, Anatoly
Vlasenkova, Svetlana
Lendina, Irina
Cherniak, Veronika
Suvorov, Dmitrii
author_sort Stoma, Igor
collection PubMed
description BACKGROUND: Intestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies. OBJECTIVES: The objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies. METHODS: In a tertiary hematology center, adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457. RESULTS: Short-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17–9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs. 12.9%), but overall in the 90-day observation period, it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed. CONCLUSIONS: This study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects.
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spelling pubmed-59379732018-05-11 Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial Stoma, Igor Karpov, Igor Iskrov, Igor Krivenko, Svetlana Uss, Anatoly Vlasenkova, Svetlana Lendina, Irina Cherniak, Veronika Suvorov, Dmitrii Mediterr J Hematol Infect Dis Original Article BACKGROUND: Intestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies. OBJECTIVES: The objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies. METHODS: In a tertiary hematology center, adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457. RESULTS: Short-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17–9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs. 12.9%), but overall in the 90-day observation period, it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed. CONCLUSIONS: This study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects. Università Cattolica del Sacro Cuore 2018-05-01 /pmc/articles/PMC5937973/ /pubmed/29755707 http://dx.doi.org/10.4084/MJHID.2018.030 Text en This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Stoma, Igor
Karpov, Igor
Iskrov, Igor
Krivenko, Svetlana
Uss, Anatoly
Vlasenkova, Svetlana
Lendina, Irina
Cherniak, Veronika
Suvorov, Dmitrii
Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title_full Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title_fullStr Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title_full_unstemmed Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title_short Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial
title_sort decolonization of intestinal carriage of mdr/xdr gram-negative bacteria with oral colistin in patients with hematological malignancies: results of a randomized controlled trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937973/
https://www.ncbi.nlm.nih.gov/pubmed/29755707
http://dx.doi.org/10.4084/MJHID.2018.030
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