Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing Klebsiella pneumoniae
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Le résumé fourni par la source
OBJECTIVES: Invasive infections caused by KPC-producing Klebsiella pneumoniae (KPCKP) are associated with very high mortality. Because infection is usually preceded by rectal colonization, we investigated if decolonization therapy (DT) with aminoglycosides had a protective effect in selected patients. METHODS: Patients with rectal colonization by colistin-resistant KPCKP who were at high risk of developing infection (because of neutropenia, surgery, previous recurrent KPCKP infections or multiple comorbidities) were followed for 180 days. Cox regression analysis including a propensity score was used to investigate the impact of the use of two intestinal decolonization regimens with oral aminoglycosides (gentamicin and neomycin/streptomycin) on mortality, risk of KPCKP infections and microbiological success. The study was registered with ClinicalTrials.gov (NCT02604849). RESULTS: The study sample comprised 77 colonized patients, of which 44 (57.1%) received DT. At 180 days of follow-up, decolonization was associated with a lower risk of mortality in multivariate analyses (HR 0.18; 95% CI 0.06-0.55) and a lower risk of KPCKP infections (HR 0.14; 95% CI 0.02-0.83) and increased microbiological success (HR 4.06; 95% CI 1.06-15.6). Specifically, gentamicin oral therapy was associated with a lower risk of crude mortality (HR 0.15; 95% CI 0.04-0.54), a lower risk of KPCKP infections (HR 0.86; 95% CI 0.008-0.94) and increased microbiological response at 180 days of follow-up (HR 5.67; 95% CI 1.33-24.1). Neomycin/streptomycin therapy was only associated with a lower risk of crude mortality (HR 0.22; 95% CI 0.06-0.9). CONCLUSIONS: Intestinal decolonization with aminoglycosides is associated with a reduction in crude mortality and KPCKP infections at 180 days after initiating treatment.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé, mais le titre doit être comparé manuellement.
- Titre Crossref
- Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing <i>Klebsiella pneumoniae</i>
- Date Crossref
- 26/07/2016
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Instituto Maimónides de Investigación Biomédica de Córdoba pays non établi dans la noticeStructure de recherche
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Hospital Universitario Reina Sofía Unit of Infectious Diseases pays non établi dans la noticeÉtablissement de santé
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University of Córdoba pays non établi dans la noticeUniversité ou école supérieure
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Hospital Universitario Virgen Macarena pays non établi dans la noticeÉtablissement de santé
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Universidad de Sevilla pays non établi dans la noticeUniversité ou école supérieure
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Hospital Universitario de Jerez Unit of Infectious Diseases pays non établi dans la noticeÉtablissement de santé
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Hospital Universitario Virgen del Rocío pays non établi dans la noticeÉtablissement de santé
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Clinical Microbiology and Preventive Medicine Unit of Infectious Diseases pays non établi dans la noticeÉtablissement de santé
Instituto Maimónides de Investigación Biomédica de Córdoba, Unit of Infectious Diseases — Hospital Universitario Reina Sofía et University of Córdoba, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.