AUTHOR=Pellicé Martina , Rodríguez-Núñez Olga , Rico Verónica , Agüero Daiana , Morata Laura , Cardozo Celia , Puerta-Alcalde Pedro , Garcia-Vidal Carolina , Rubio Elisa , Fernandez-Pittol Mariana J. , Vergara Andrea , Pitart Cristina , Marco Francesc , Santana Gemina , Rodríguez-Serna Laura , Vilella Ana , López Ester , Soriano Alex , Martínez Jose Antonio , Del Rio Ana 

TITLE=Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting

JOURNAL=Frontiers in Microbiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.630826

DOI=10.3389/fmicb.2021.630826

ISSN=1664-302X

ABSTRACT=<p><bold>Background:</bold> KPC-producing <italic>Klebsiella pneumoniae</italic> (KPCKP) is a threat for patients admitted to healthcare institutions.</p><p><bold>Objectives:</bold> To assess the efficacy of several decolonization strategies for KPCKP rectal carriage.</p><p><bold>Methods:</bold> Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak.</p><p><bold>Results:</bold> Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone (<italic>n</italic> = 26, 35.6%) or followed by a probiotic (<italic>n</italic> = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), <italic>p</italic> = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), <italic>p</italic> = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78–14.7, <italic>p</italic> = 0.09).</p><p><bold>Conclusion:</bold> In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study.</p>