A 5-day course of oral antibiotics followed by faecal transplantation to eradicate carriage of multidrug-resistant Enterobacteriaceae: a randomized clinical trial.
Administration, Oral
Aged
Anti-Bacterial Agents
/ therapeutic use
Carbapenem-Resistant Enterobacteriaceae
/ drug effects
Carrier State
/ drug therapy
Colistin
/ therapeutic use
Drug Administration Schedule
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae Infections
/ drug therapy
Fecal Microbiota Transplantation
Feces
/ microbiology
Female
Humans
Male
Middle Aged
Tertiary Care Centers
beta-Lactamases
Carbapenemase
Colistin
Extended-spectrum β-lactamase
Faecal microbiota transplantation
Neomycin
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
31
10
2018
revised:
07
12
2018
accepted:
09
12
2018
pubmed:
8
1
2019
medline:
5
11
2019
entrez:
8
1
2019
Statut:
ppublish
Résumé
Intestinal carriage with extended spectrum β-lactamase Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) can persist for months. We aimed to evaluate whether oral antibiotics followed by faecal microbiota transplantation (FMT) can eradicate intestinal carriage with ESBL-E/CPE. Randomized, open-label, superiority trial in four tertiary-care centres (Geneva (G), Paris (P), Utrecht (U), Tel Aviv (T)). Non-immunocompromised adult patients were randomized 1: 1 to either no intervention (control) or a 5-day course of oral antibiotics (colistin sulphate 2 × 10 Thirty-nine patients (G = 14; P = 16; U = 7; T = 2) colonized by ESBL-E (n = 36) and/or CPE (n = 11) were enrolled between February 2016 and June 2017. In the intention-to-treat analysis 9/22 (41%) patients assigned to the intervention arm were negative for ESBL-E/CPE at V4 (1/22 not receiving the intervention imputed as positive) whereas in the control arm 5/17 (29%) patients were negative (one lost to follow up imputed as negative) resulting in an OR for decolonization success of 1.7 (95% CI 0.4-6.4). Study drugs were well tolerated overall but three patients in the intervention group prematurely stopped the study antibiotics because of diarrhoea (all received FMT). Non-absorbable antibiotics followed by FMT slightly decreased ESBL-E/CPE carriage compared with controls; this difference was not statistically significant, potentially due to early trial termination. Further clinical investigations seem warranted.
Identifiants
pubmed: 30616014
pii: S1198-743X(18)30796-1
doi: 10.1016/j.cmi.2018.12.009
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
beta-Lactamases
EC 3.5.2.6
Colistin
Z67X93HJG1
Banques de données
ClinicalTrials.gov
['NCT02472600']
Types de publication
Equivalence Trial
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
830-838Investigateurs
L Colle
(L)
F Kloosterman
(F)
W van Bentum-Puijk
(W)
J Vlooswijk
(J)
A Andremont
(A)
M Ben Hayoun
(M)
E Canoui
(E)
A Chabrol
(A)
N Gamany
(N)
M Lafaurie
(M)
A Lefort
(A)
R Lepeule
(R)
Z Louis
(Z)
E Rondinaud
(E)
H Sadou Yayé
(H)
L Sarfati
(L)
V Zarrouk
(V)
C Brossier
(C)
L Carrez
(L)
V Lazarevic
(V)
G Renzi
(G)
E von Dach
(E)
S Cohen Percia
(S)
R Shvartz
(R)
J Lellouche
(J)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.