Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

Abstract

Carbapenemase-producing Klebsiella pneumoniae (CPKP) is rapidly emerging as a leading nosocomial infection in many countries, especially in Italy where it is considered endemic. In this paper we briefly summarize the main characteristics of this outbreak, focusing on its recent spread to elderly frail patients admitted to internal medicine and geriatric wards. Severity of disease, clinical complexity and a large number of comorbidities seem to be major risk factors in clinical practice, although scientific evidence is still lacking, since until now studies have been carried out mainly in intensive care settings. We also discuss the possible role of gut microbiota in CPKP colonization onset and the possible role of pre-probiotics in promoting eradication.

Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting

“…Regarding KPCKP, a small pilot trial has been mentioned in an Italian journal in which 36 elderly frail hospitalized patients were randomized to receive high-dose probiotic and psyllium for 14 days or standard care. The authors reported a significant reduction in carriage rate in the probiotic group during hospitalization (53 vs. 12%, p = 0.009; Nouvenne et al, 2015 ).…”

ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers

“…In the RCT by Saidel-Odes et al, significant carriage rate reduction was observed 7 days post-treatment (38.8% versus 83.9%; OR 0.13; 95% CI 0.02e0.74; p < 0.0016), but the effect was lost at 28 days, resulting in a non-significant difference between the two groups (41.5% versus 66.7%) [51]. In the RCT by Nouvenne et al, significant reduction in carriage rate during hospitalization was associated with administration of high-dose probiotics (p 0.009) [52]. In the semi-randomized trial by Oren et al, the eradication rate during follow up was significantly higher in the intervention group (56% (22/50) versus 7% (7/102); p < 0.001) [53].…”

“…Oren et al observed a reduction in allcause mortality without impact on attributable mortality during the follow-up period (timing not specified) (22% (11/50) versus 53% (54/102); p < 0.001) [53]. Nouvenne et al and Lubbert et al did not find any significant effect of decolonization treatment on mortality during hospitalization [52,54].…”

“…The 11 studies were performed in Europe ( 6), Israel (3), South Africa (1) and the USA (1): two RCTs [51,52], one semi-randomized control trial [53], two retrospective cohort studies [54,55], and six case series and case reports without comparators [56e61]. Two studies had a multicentre design [55,59].…”

“…Nouvenne et al performed an RCT in 32 patients assessing the role of high-dose probiotics in CRE faecal carriage eradication. The patients were randomly assigned to either highdose probiotics and psyllium for 14 days or standard care [52]. Oren et al evaluated 50 patients treated with one of three regimens: colistin sulphate (2 MU four times daily), gentamicin sulphate (80 mg four times daily), or both [53].…”