ORAL GENTAMICIN THERAPY FOR CARBAPENEM-RESISTENT KLEBSIELLA PNEUMONIAE INFECTIONS IN HEMATOLOGIC PATIENTS: A SINGLE CENTER EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Simonetti F. 06/09/16; 132721; E1172
Dr. Federico Simonetti
Contributions
Contributions
Abstract
Abstract: E1172
Type: Eposter Presentation
Background
The worldwide spread of carbapenem-resistant Klebsiella pneumoniae (KPC-Kp) is nowadays a health threat worldwide. KPC-Kp mortality infections range from 18 to 48% and depend on the type of therapy administered; mono vs combo therapy. This result may be due to delayed time to active therapy, pharmacologic limitations of available treatment options, and the fact that patients with KPC-Kp infections tend to be critically ill. Patients with hematologic malignancies and hematopoietic stem cell transplant recipients are more vulnerable to Carbapenemase-resistant Enterobacteriaceae (CRE) because of chemotherapy-induced gastrointestinal mucositis, prolonged hospitalizations and neutropenia, and frequent use of broad-spectrum antibacterial agents. Mortality in these patients might be as high as 85%.
Aims
The aim of our study was to test he efficacy of oral gentamicin in gut decontamination from KPC-Kp in hematologic patients, in view of immunosuppressive therapy, stem cell transplantation or to prevent sepsis after chemotherapy.
Methods
We performed a prospective study in an Italian Hematology Unit to quantify the efficacy of gentamicin gut decontamination from KPC-Kp in hematologic patient with and without concomitant infection. We considered eligible all patient with rectal swab culture positive for KPC-Kp with hematologic disease and those patients were administered oral gentamicin (80 mg four times daily) for 7 to 25 days, having stopped the therapy three days after the proved decontamination. Rectal swab cultures were performed at the time of hospital admission and every 3 days thereafter.
Results
Fourteen patients with a hematologic disease and concomitant KPC-Kp positive rectal swab culture were enrolled in the study; only one was resistant to gentamycin. The patients were 5 female and 9 male, with a mean age of 68.5 years (range 39 – 80 years). Concomitant systemic associated therapy (CSAT) was administered to 4/14 patients due to systemic infections. The enrolled patients were treated with oral gentamicin for 7 to 25 days and the overall decontamination rate in the entire study population administered oral gentamicin was 71% (10/14). Only two patients took gentamicin for more than 15 days. Four patients were not decolonized by gentamicin oral therapy: one of these was the patient harbouring gentamicin-resistant strain and 3 patients have CSAT. One out of this 4 patients died for KPC-Kp sepsis. At 1 month of follow-up, no one KPC-Kp re-infection was documented. The decontamination rate was 90% (9/10) in patients receiving oral gentamicin only, versus 25% (1/4) in those also treated with CSAT. No new gentamicin-resistant KPC-Kp strain was isolated during oral gentamycin therapy.
Conclusion
The KPC-Kp infection are associated with high mortality and morbidity, especially in Intensive Care Units and hematologic patients; prevention of KPC-Kp infection is the first provision to implement, followed by the screening for gut colonization and eventually gut decolonization. In our experience the decontaminations rate in the entire population was 71% and 90% considering the patients receiving oral gentamicin only. Although the small number of patients analyzed in this study, our results were similar to others suggesting that the selective pressure of CSAT on gut microbiota may favor the persistent carriage of KPC-Kp, thereby contributing on the higher failure rates observed versus monotherapy. Therefore, the selective oral decontamination therapy of KPC-Kp with oral gentamicin is safe and possibly effective.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Type: Eposter Presentation
Background
The worldwide spread of carbapenem-resistant Klebsiella pneumoniae (KPC-Kp) is nowadays a health threat worldwide. KPC-Kp mortality infections range from 18 to 48% and depend on the type of therapy administered; mono vs combo therapy. This result may be due to delayed time to active therapy, pharmacologic limitations of available treatment options, and the fact that patients with KPC-Kp infections tend to be critically ill. Patients with hematologic malignancies and hematopoietic stem cell transplant recipients are more vulnerable to Carbapenemase-resistant Enterobacteriaceae (CRE) because of chemotherapy-induced gastrointestinal mucositis, prolonged hospitalizations and neutropenia, and frequent use of broad-spectrum antibacterial agents. Mortality in these patients might be as high as 85%.
Aims
The aim of our study was to test he efficacy of oral gentamicin in gut decontamination from KPC-Kp in hematologic patients, in view of immunosuppressive therapy, stem cell transplantation or to prevent sepsis after chemotherapy.
Methods
We performed a prospective study in an Italian Hematology Unit to quantify the efficacy of gentamicin gut decontamination from KPC-Kp in hematologic patient with and without concomitant infection. We considered eligible all patient with rectal swab culture positive for KPC-Kp with hematologic disease and those patients were administered oral gentamicin (80 mg four times daily) for 7 to 25 days, having stopped the therapy three days after the proved decontamination. Rectal swab cultures were performed at the time of hospital admission and every 3 days thereafter.
Results
Fourteen patients with a hematologic disease and concomitant KPC-Kp positive rectal swab culture were enrolled in the study; only one was resistant to gentamycin. The patients were 5 female and 9 male, with a mean age of 68.5 years (range 39 – 80 years). Concomitant systemic associated therapy (CSAT) was administered to 4/14 patients due to systemic infections. The enrolled patients were treated with oral gentamicin for 7 to 25 days and the overall decontamination rate in the entire study population administered oral gentamicin was 71% (10/14). Only two patients took gentamicin for more than 15 days. Four patients were not decolonized by gentamicin oral therapy: one of these was the patient harbouring gentamicin-resistant strain and 3 patients have CSAT. One out of this 4 patients died for KPC-Kp sepsis. At 1 month of follow-up, no one KPC-Kp re-infection was documented. The decontamination rate was 90% (9/10) in patients receiving oral gentamicin only, versus 25% (1/4) in those also treated with CSAT. No new gentamicin-resistant KPC-Kp strain was isolated during oral gentamycin therapy.
Conclusion
The KPC-Kp infection are associated with high mortality and morbidity, especially in Intensive Care Units and hematologic patients; prevention of KPC-Kp infection is the first provision to implement, followed by the screening for gut colonization and eventually gut decolonization. In our experience the decontaminations rate in the entire population was 71% and 90% considering the patients receiving oral gentamicin only. Although the small number of patients analyzed in this study, our results were similar to others suggesting that the selective pressure of CSAT on gut microbiota may favor the persistent carriage of KPC-Kp, thereby contributing on the higher failure rates observed versus monotherapy. Therefore, the selective oral decontamination therapy of KPC-Kp with oral gentamicin is safe and possibly effective.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Abstract: E1172
Type: Eposter Presentation
Background
The worldwide spread of carbapenem-resistant Klebsiella pneumoniae (KPC-Kp) is nowadays a health threat worldwide. KPC-Kp mortality infections range from 18 to 48% and depend on the type of therapy administered; mono vs combo therapy. This result may be due to delayed time to active therapy, pharmacologic limitations of available treatment options, and the fact that patients with KPC-Kp infections tend to be critically ill. Patients with hematologic malignancies and hematopoietic stem cell transplant recipients are more vulnerable to Carbapenemase-resistant Enterobacteriaceae (CRE) because of chemotherapy-induced gastrointestinal mucositis, prolonged hospitalizations and neutropenia, and frequent use of broad-spectrum antibacterial agents. Mortality in these patients might be as high as 85%.
Aims
The aim of our study was to test he efficacy of oral gentamicin in gut decontamination from KPC-Kp in hematologic patients, in view of immunosuppressive therapy, stem cell transplantation or to prevent sepsis after chemotherapy.
Methods
We performed a prospective study in an Italian Hematology Unit to quantify the efficacy of gentamicin gut decontamination from KPC-Kp in hematologic patient with and without concomitant infection. We considered eligible all patient with rectal swab culture positive for KPC-Kp with hematologic disease and those patients were administered oral gentamicin (80 mg four times daily) for 7 to 25 days, having stopped the therapy three days after the proved decontamination. Rectal swab cultures were performed at the time of hospital admission and every 3 days thereafter.
Results
Fourteen patients with a hematologic disease and concomitant KPC-Kp positive rectal swab culture were enrolled in the study; only one was resistant to gentamycin. The patients were 5 female and 9 male, with a mean age of 68.5 years (range 39 – 80 years). Concomitant systemic associated therapy (CSAT) was administered to 4/14 patients due to systemic infections. The enrolled patients were treated with oral gentamicin for 7 to 25 days and the overall decontamination rate in the entire study population administered oral gentamicin was 71% (10/14). Only two patients took gentamicin for more than 15 days. Four patients were not decolonized by gentamicin oral therapy: one of these was the patient harbouring gentamicin-resistant strain and 3 patients have CSAT. One out of this 4 patients died for KPC-Kp sepsis. At 1 month of follow-up, no one KPC-Kp re-infection was documented. The decontamination rate was 90% (9/10) in patients receiving oral gentamicin only, versus 25% (1/4) in those also treated with CSAT. No new gentamicin-resistant KPC-Kp strain was isolated during oral gentamycin therapy.
Conclusion
The KPC-Kp infection are associated with high mortality and morbidity, especially in Intensive Care Units and hematologic patients; prevention of KPC-Kp infection is the first provision to implement, followed by the screening for gut colonization and eventually gut decolonization. In our experience the decontaminations rate in the entire population was 71% and 90% considering the patients receiving oral gentamicin only. Although the small number of patients analyzed in this study, our results were similar to others suggesting that the selective pressure of CSAT on gut microbiota may favor the persistent carriage of KPC-Kp, thereby contributing on the higher failure rates observed versus monotherapy. Therefore, the selective oral decontamination therapy of KPC-Kp with oral gentamicin is safe and possibly effective.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Type: Eposter Presentation
Background
The worldwide spread of carbapenem-resistant Klebsiella pneumoniae (KPC-Kp) is nowadays a health threat worldwide. KPC-Kp mortality infections range from 18 to 48% and depend on the type of therapy administered; mono vs combo therapy. This result may be due to delayed time to active therapy, pharmacologic limitations of available treatment options, and the fact that patients with KPC-Kp infections tend to be critically ill. Patients with hematologic malignancies and hematopoietic stem cell transplant recipients are more vulnerable to Carbapenemase-resistant Enterobacteriaceae (CRE) because of chemotherapy-induced gastrointestinal mucositis, prolonged hospitalizations and neutropenia, and frequent use of broad-spectrum antibacterial agents. Mortality in these patients might be as high as 85%.
Aims
The aim of our study was to test he efficacy of oral gentamicin in gut decontamination from KPC-Kp in hematologic patients, in view of immunosuppressive therapy, stem cell transplantation or to prevent sepsis after chemotherapy.
Methods
We performed a prospective study in an Italian Hematology Unit to quantify the efficacy of gentamicin gut decontamination from KPC-Kp in hematologic patient with and without concomitant infection. We considered eligible all patient with rectal swab culture positive for KPC-Kp with hematologic disease and those patients were administered oral gentamicin (80 mg four times daily) for 7 to 25 days, having stopped the therapy three days after the proved decontamination. Rectal swab cultures were performed at the time of hospital admission and every 3 days thereafter.
Results
Fourteen patients with a hematologic disease and concomitant KPC-Kp positive rectal swab culture were enrolled in the study; only one was resistant to gentamycin. The patients were 5 female and 9 male, with a mean age of 68.5 years (range 39 – 80 years). Concomitant systemic associated therapy (CSAT) was administered to 4/14 patients due to systemic infections. The enrolled patients were treated with oral gentamicin for 7 to 25 days and the overall decontamination rate in the entire study population administered oral gentamicin was 71% (10/14). Only two patients took gentamicin for more than 15 days. Four patients were not decolonized by gentamicin oral therapy: one of these was the patient harbouring gentamicin-resistant strain and 3 patients have CSAT. One out of this 4 patients died for KPC-Kp sepsis. At 1 month of follow-up, no one KPC-Kp re-infection was documented. The decontamination rate was 90% (9/10) in patients receiving oral gentamicin only, versus 25% (1/4) in those also treated with CSAT. No new gentamicin-resistant KPC-Kp strain was isolated during oral gentamycin therapy.
Conclusion
The KPC-Kp infection are associated with high mortality and morbidity, especially in Intensive Care Units and hematologic patients; prevention of KPC-Kp infection is the first provision to implement, followed by the screening for gut colonization and eventually gut decolonization. In our experience the decontaminations rate in the entire population was 71% and 90% considering the patients receiving oral gentamicin only. Although the small number of patients analyzed in this study, our results were similar to others suggesting that the selective pressure of CSAT on gut microbiota may favor the persistent carriage of KPC-Kp, thereby contributing on the higher failure rates observed versus monotherapy. Therefore, the selective oral decontamination therapy of KPC-Kp with oral gentamicin is safe and possibly effective.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
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