Intestinal decolonization of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL): a retrospective observational study in patients at risk for infection and a brief review of the literature

摘要: Multidrug-resistant Escherichia coli and other enteric bacteria producing extended-spectrum β-lactamases (ESBL) have emerged as an important cause of invasive infection. Targeting the primary (intestinal) niche by decolonization may be a valuable approach to decrease risk relapsing infections reduce transmission ESBL-producing pathogens. In retrospective observational study we evaluated efficacy intestinal treatment using orally administered colistin or non-absorbable agents given for 2 4 weeks in adult patients with previous infection persistent colonization ESBL-positive Enterobacteriaceae (ESBL-E). Eradication success was defined negative rectal swab stool culture at end follow up-2 weeks after discontinuation. First-line led eradication ESBL-E 19/45 (42 %, 7/18 low-dose [4 × 1 million units] colistin, 3/12 high-dose 9/15 rifaximin [2 400 mg]), secondary/salvage successful 8/13 (62 %, 20 episodes). Late follow-up showed that 7/13 (54 %) initial salvage became recolonized within 3 months post-treatment assessment while all eight failing late remained colonized. A narrative review literature confirms limited antibiotics including conventional selective digestive tract (SDD)-like combination regimens eradicating multidrug-resistant from tract. At present, there is no clear evidence significant single-drug oral antibiotics. More effective are needed better definition required planning meaningful randomized controlled studies this field.