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Microbial Issues

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

Bone Marrow Transplantation volume 46, pages 1226–1230 (2011)Cite this article

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Abstract

Following an outbreak of carbapenem resistant Klebsiella pneumoniae (CRKP) bacteremia among inpatients in the Hemato-oncology and BMT unit, we studied the course of this infection in patients undergoing intensive chemotherapy and SCT. In addition, we conducted a pilot study aimed to eradicate CRKP colonization in the gastrointestinal tract, using oral gentamicin. Adult patients admitted to the BMT unit, identified as CRKP carriers on surveillance rectal cultures, were included in the study. Oral gentamicin at a dose of 80 mg q.i.d. was administered to all identified carriers until eradication. Among 15 colonized patients included in the study, the eradication rate achieved was 66% (10/15); discontinuation of persistent bacteremia occurred in 62.5% (5/8) and nosocomial spread of CRKP carrier state ceased. Administration of intensive chemotherapy and SCT is feasible, although associated with increased risk. Hematological patients in need of intensive chemotherapy/SCT should not be denied the required treatment on the basis of being CRKP carriers. Oral gentamicin treatment for eradication of CRKP from the gastrointestinal reservoir could serve as additional tool in the combat against the nosocomial spread and severe infections caused by this difficult-to-treat organism.

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References

  1. NNIS System. National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31: 481–498.

    Article  Google Scholar 

  2. Bishara J, Livne G, Ashkenazi S, Levy I, Pitlik S, Ofir O et al. Antibacterial susceptibility of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli. Isr Med Assoc J 2005; 7: 298–301.

    CAS  PubMed  Google Scholar 

  3. Livermore DM . Beta-lactamase-mediated resistance and opportunities for its control. J Antimicrob Chemother 1998; 41 (Suppl D): 25–41.

    Article  CAS  PubMed  Google Scholar 

  4. Garau J . Beta-lactamases: current situation and clinical importance. Intensive Care Med 1994; 20 (Suppl 3): S5–S9.

    Article  PubMed  Google Scholar 

  5. Moland ES, Black JA, Ourada J, Reisbig MD, Hanson ND, Thomson KS . Occurrence of newer beta-lactamases in Klebsiella pneumoniae isolates from 24 U.S. hospitals. Antimicrob Agents Chemother 2002; 46: 3837–3842.

    Article  CAS  PubMed  Google Scholar 

  6. Miriagou V, Tzouvelekis LS, Rossiter S, Tzelepi E, Angulo FJ, Whichard JM . Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2. Antimicrob Agents Chemother 2003; 47: 1297–1300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Deshpande LM, Jones RN, Fritsche TR, Sader HS . Occurrence and characterization of carbapenemase-producing Enterobacteriaceae: report from the SENTRY Antimicrobial Surveillance Program (2000–2004). Microb Drug Resist 2006; 12: 223–230.

    Article  CAS  PubMed  Google Scholar 

  8. Woodford N, Tierno Jr PM, Young K, Tysall L, Palepou MF, Ward E et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York Medical Center. Antimicrob Agents Chemother 2004; 48: 4793–4799.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bradford PA, Bratu S, Urban C, Visalli M, Mariano N, Landman D et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis 2004; 39: 55–60.

    Article  CAS  PubMed  Google Scholar 

  10. Samra Z, Ofir O, Lishtzinsky Y, Madar-Shapiro L, Bishara J . Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007; 30: 525–529.

    Article  CAS  PubMed  Google Scholar 

  11. Bratu S, Landman D, Haag R, Recco R, Eramo A, Alam M et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005; 165: 1430–1435.

    Article  CAS  PubMed  Google Scholar 

  12. Leavitt A, Navon-Venezia S, Chmelnitsky I, Schwaber MJ, Carmeli Y . Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007; 51: 3026–3029.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Nordmann P, Cuzon G, Naas T . The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009; 9: 228–236.

    Article  CAS  PubMed  Google Scholar 

  14. Schwaber MJ, Carmeli Y . Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA 2008; 300: 2911–2913.

    Article  CAS  PubMed  Google Scholar 

  15. Yu VL, Hansen DS, Ko WC, Sagnimeni A, Klugman KP, von Gottberg A et al. Virulence characteristics of Klebsiella and clinical manifestations of K.pneumoniae bloodstream infections. Emerg Infect Dis 2007; 13: 986–993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003; 362: 1011–1016.

    Article  CAS  PubMed  Google Scholar 

  17. van Saene HK, Petros AJ, Ramsay G, Baxby D . All great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truth. Intensive Care Med 2003; 29: 677–690.

    Article  PubMed  Google Scholar 

  18. de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360: 20–31.

    Article  CAS  PubMed  Google Scholar 

  19. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Clinical and Laboratory Standards Institute, Wayne, PA 2006 (16th informational supplement): M100-S16.

  20. Kotlovsky T, Shalginov R, Austin L, Sprecher H . Rapid detection of bla(KPC)-positive Klebsiella pneumoniae in a clinical setting. Eur J Clin Microbiol Infect Dis 2009; 28: 309–311.

    Article  CAS  PubMed  Google Scholar 

  21. Hussein K, Sprecher H, Mashiach T, Oren I, Kassis I, Finkelstein R . Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009; 30: 666–671.

    Article  PubMed  Google Scholar 

  22. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009; 58: 256–260.

  23. Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP . Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008; 29: 1099–1106.

    Article  PubMed  Google Scholar 

  24. Troche G, Joly LM, Guibert M, Zazzo JF . Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey. Infect Control Hosp Epidemiol 2005; 26: 161–165.

    Article  PubMed  Google Scholar 

  25. Paterson DL, Singh N, Rihs JD, Squier C, Rihs BL, Muder RR . Control of an outbreak of infection due to extended-spectrum beta-lactamase—producing Escherichia coli in a liver transplantation unit. Clin Infect Dis 2001; 33: 126–128.

    Article  CAS  PubMed  Google Scholar 

  26. Siegel JD, Rhinehart E, Jackson M, Chiarello L, The Healthcare Infection Control Practices Advisory, Committee. Management of multidrug resistant organisms in healthcare settings. 2006. Am J Infect Control 2007; 35 (10 Suppl 2): S165–S193.

    Article  PubMed  Google Scholar 

  27. Borer A, Saidel-Odes L, Riesenberg K, Eskira S, Peled N, Nativ R et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009; 30: 972–976.

    Article  PubMed  Google Scholar 

  28. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730–751.

    Article  PubMed  Google Scholar 

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Author notes

  1. T Zuckerman and I Oren: These authors contributed equally to this work.

Authors and Affiliations

  1. Hematology Department, Rambam Health Care Campus, Haifa, Israel

    T Zuckerman, N Benyamini, R Fineman & J M Rowe

  2. Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    T Zuckerman, R Finkelstein, J M Rowe & I Oren

  3. Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel

    H Sprecher

  4. Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel

    R Finkelstein & I Oren

Authors
  1. T Zuckerman
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  2. N Benyamini
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  4. R Fineman
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  5. R Finkelstein
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Correspondence to T Zuckerman.

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Zuckerman, T., Benyamini, N., Sprecher, H. et al. SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state. Bone Marrow Transplant 46, 1226–1230 (2011). https://doi.org/10.1038/bmt.2010.279

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