Decolonization Strategies for Multidrug-Resistant Enterobacteriaceae

Multidrug-resistant Enterobacteriaceae pose a major threat in healthcare and community settings through silent carriage in the gastrointestinal tract. Asymptomatic colonization acts as a reservoir for invasive infection and horizontal transmission of resistance determinants. Decolonization aims to eradicate or suppress carriage without causing widespread ecological disturbance. Strategies range from non-absorbable antibiotics administered orally to targeted regimens combining prebiotics, probiotics or bacteriophages, and host- and pathogen-directed therapies. Selective digestive decontamination employs topical agents to clear high-risk species, while novel methods seek to preserve commensal flora and limit collateral resistance. Rapid molecular quantification of intestinal loads guides personalised interventions and measures impact. Global implementation hinges on balancing efficacy, safety and sustainability to curb the spread of carbapenemase- and extended-spectrum β-lactamase-producing strains and ultimately reduce infection rates and transmission.

Research from Nature Portfolio

An animal model has demonstrated that rifaximin, a non-absorbable antibiotic, achieves inhibitory concentrations against the majority of carbapenem-resistant Klebsiella pneumoniae isolates in vitro and significantly reduces intestinal carriage in vivo. Pre-treatment with a broad-spectrum antibiotic was required to establish colonization, after which a seven-day rifaximin course led to marked declines in faecal and tissue bacterial loads. These findings support the potential of rifaximin as a decolonizing agent at gut-achievable dosages, offering a framework for human studies and informing dosing regimens to control asymptomatic carriage of carbapenemase-producing Enterobacteriaceae.

Decolonization Strategies for Multidrug-Resistant Enterobacteriaceae publication trend

The graph below shows the total number of articles in decolonization strategies for multidrug-resistant enterobacteriaceae across all publications each year (not limited to Nature Index journals).

Technical terms

Decolonization: The process of eliminating asymptomatic carriage of pathogenic bacteria from a specific anatomical site, typically the gut.

Selective digestive decontamination (SDD): A prophylactic regimen of non-absorbable antimicrobials applied to the oropharynx and gastrointestinal tract to eradicate select pathogens while preserving commensal flora.

Carbapenem-resistant Enterobacteriaceae (CRE): Members of the Enterobacteriaceae family that have acquired mechanisms, such as carbapenemase enzymes, conferring resistance to carbapenem antibiotics.

Bacteriophage: A virus that specifically infects and lyses bacteria, explored as a precision tool to reduce multidrug-resistant populations without broad microbiota disruption.

References

1. Decolonization of asymptomatic carriage of multi-drug resistant bacteria by bacteriophages?. Frontiers in Microbiology (2023).
2. An animal model of limitation of gut colonization by carbapenemase-producing Klebsiella pneumoniae using rifaximin. Scientific Reports (2022).
3. Efficacy and Safety of Oral Neomycin for the Decolonization of Carbapenem-Resistant Enterobacterales: An Open-Label Randomized Controlled Trial. Antibiotics (2024).
4. Proof‑of‑concept study to quantify changes in intestinal loads of KPC-producing Klebsiella pneumoniae in colonised patients following selective digestive decontamination with oral gentamicin. Journal of Global Antimicrobial Resistance (2022).