532. Can Saccharomyces boulardii Therapy Be Effective in Decolonizing Rectal Carbapenem-Resistant Enterobacteriaceae (CRE) Colonization?

Abstract

BackgroundCRE are globally important pathogens associated with significant morbidity and mortality. The problem of carrying CRE may continue to create a problem in discharged cases in the community. Saccharomyces boulardii sachet therapy (SBST) is reported to cause decolonization in several MDR bacteria carriers. Herein, it is aimed to present the decolonizing rates of rectal CRE colonized cases after SBST treatment.MethodsThe study period was August 2018–March 2019. Inclusion criteria were: (i) age >18, (ii) receiving Saccharomyces boulardii 250 mg sachets q12h for 7 days, (iii) being proven CRE carrier on rectal swab culture (RSC) up to 5 days period before SBST. The first repeated RSC was performed 3–5 days after the end of SBST. Data were retrieved from the hospital electronic database. Cases with three consecutive weekly performed negative RSC were considered to be decolonized. RSC were processed according to CDC protocol; briefly, the swab was inoculated into 10 mL of trypticase soy broth (bioMérieux Inc., Marcy-l’Étoile, France) with the addition of one 10-μg ertapenem disk (Oxoid, Altrincham, UK) and incubated at 35°C for 18–20 h. The next day, after vortexing, 100 μL of the inoculum was subcultured (8) onto chromID CARBA agar plates (bioMérieux) and incubated at 35°C for 18–20 h. Suspected CRE colonies on chromID CARBA (blue/green to blue/gray in color) were identified by the VITEK MS system (bioMérieux). Susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Isolates were tested for their resistance phenotypes to imipenem, ertapenem, and meropenem by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria.ResultsFifteen cases [2 women, mean age 60.6 ± 18.3 (min. 18–max. 83)] fulfilled the inclusion criteria. All had a history of carbapenem usage. Five cases (33%) had three consequent negative RSC after SBST and were considered to be decolonized. Twelve cases were receiving concomitant antibiotic during SBST (10 carbapenem based regimens). Three cases who received no concomitant antibiotic were decolonized.ConclusionSBST may be a promising tool for decolonizing CRE carriers. These data need to be validated in larger cohorts preferably via randomized-controlled trials.Disclosures All authors: No reported disclosures.

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study

“…Regarding Enterobacteriaceae, only one randomized control trial showed eradication of ESBL Enterobacteriaceae, but the result was not statistically significant [27]. Furthermore, some nonrandomized studies have demonstrated clearance of CRE [9,28]. However, these studies did not encompass a large number of patients or an adequate follow-up period to effectively demonstrate the MDRO clearance efficacy of probiotics.…”

“…Saccharomyces boulardii and Lactobacillus rhamnosus were selected as probiotics because they have been shown to decolonize MDRO [7,9]. Furthermore, Inha University Hospital has operated a CRE screening program since 2017; therefore, all patients admitted to the ICU have been screened from admission to discharge every 15 days.…”

“…The following risk factors affecting new CRE colonization were considered: age, sex, ICU category, length of stay, tube feeding, probiotics administration and duration, proton pump inhibitor administration and duration, carbapenem administration and duration, antibiotics other than carbapenem, and comorbidity. Saccharomyces boulardii and Lactobacillus rhamnosus were selected as probiotics because they have been shown to decolonize MDRO [7,9]. Furthermore, Inha University Hospital has operated a CRE screening program since 2017; therefore, all patients admitted to the ICU have been screened from admission to discharge every 15 days.…”