Drug regimen may eliminate colonization with superbug CRE

(Press-News.org) Contact information: Liz Garman
egarman@apic.org
202-454-2604
Association for Professionals in Infection Control
Drug regimen may eliminate colonization with superbug CRE Washington, DC, November 25, 2013 – Orally administered, nonabsorbable antibiotics were effective in eradicating carbapenem-resistant Enterobacteriaceae (CRE) colonization, according to a new study published in the December issue of the American Journal of Infection Control, a publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

Researchers at Rambam Health Care Campus, a 1,000-bed, tertiary care center in Haifa, Israel, examined isolates from 152 patients who were identified as CRE carriers (colonized with the organism, but not yet showing disease) over a 24-month period. There were 50 patients in the treatment group, who received one of three drug regimens based on antibiotic sensitivities of their isolates: nonabsorbable gentamicin (26), colistin (16), or a combination of the two (8). Patients received treatment until cultures were negative for CRE, or for a maximum of 60 days.

Patients not sensitive to either antibiotic, or those who did not give consent (102), comprised the control group and were also followed (median=140 days) in order to determine the spontaneous eradication rate.

CRE was eradicated in 42 percent of patients taking gentamicin (11/26), 50 percent taking colistin (8/16), and 37.5 percent taking a combined treatment (3/8), for an overall eradication rate for patients on all treatment regimens of 44 percent (22/50). This compares to a 7 percent (7/102) eradication rate in the control group.

In patients where colonization was stamped out, regardless of whether they received treatment, there were fewer deaths than in those where colonization persisted (17 percent vs. 49 percent, respectively).

"Treatment with oral nonabsorbable antibiotics, to which CRE is susceptible, appears to be safe and effective for eradication of the CRE carrier state," say the researchers in the study. "Reducing the reservoir of CRE carriers in healthcare facilities may thereby reduce patient-to-patient transmission and the incidence of clinical infection with this difficult-to-treat organism. When mortality rate in patients who had successful eradication of the carrier state (either spontaneous or on treatment) was compared with that of patients failing eradication, significantly lower mortality was found in the former group. This could point toward a real reduction of mortality attributed to the eradication of CRE carrier state."

According to the U.S. Centers for Disease Control and Prevention (CDC), untreatable and hard-to-treat infections from CRE are on the rise among patients in medical facilities. These bacteria have become resistant to nearly all the antibiotics currently available and can transfer their resistance to other organisms. According to the CDC, almost half of patients who get bloodstream infections from CRE germs die from the infections.

### ABOUT AJIC: AMERICAN JOURNAL OF INFECTION CONTROL AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

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NOTES FOR EDITORS "Eradication of carbapenem-resistant Enterobacteriaceae gastrointestinal colonization with nonabsorbable oral antibiotic treatment: A prospective controlled trial," by Ilana Oren, Hannah Sprecher, Renato Finkelstein, Salim Hadad, Ami Neuberger, Keatam Hussein, Ayelet Raz-Pasteur, Noa Lavi, Elias Saad, Israel Henig, Netanel Horowitz, Irit Avivi, Noam Benyamini, Riva Fineman, Yishai Ofran, Nuhad Haddad, Jacob M. Rowe and Tsila Zuckerman appears in the American Journal of Infection Control, Volume 41, Issue 12 (December 2013).

Authors:

Ilana Oren, MD (Corresponding Author)
Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Hannah Sprecher, PhD
Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel

Renato Finkelstein, MD
Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Salim Hadad, PhD
Pharmacy, Rambam Health Care Campus, Haifa, Israel

Ami Neuberger, MD
Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel

Keatam Hussein, MD
Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel

Ayelet Raz-Pasteur, MD
Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel

Noa Lavi, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Elias Saad, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Israel Henig, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Netanel Horowitz, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Irit Avivi, MD
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Noam Benyamini, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Riva Fineman, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Yishai Ofran, MD
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Nuhad Haddad, MD
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Jacob M. Rowe, MD
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Tsila Zuckerman, MD
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel