Publication

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

Tacconelli, E., Mazzaferri, F., De Smet, A. M., Bragantini, D., Eggimann, P., Huttner, B. D., Kuijper, E. J., Lucet, J. -C., Mutters, N. T., Sanguinetti, M., Schwaber, M. J., Souli, M., Torre-Cisneros, J., Price, J. R. & Rodriguez-Bano, J., Jul-2019, In : Clinical Microbiology and Infection. 25, 7, p. 807-817 11 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • E. Tacconelli
  • F. Mazzaferri
  • A. M. De Smet
  • D. Bragantini
  • P. Eggimann
  • B. D. Huttner
  • E. J. Kuijper
  • J. -C. Lucet
  • N. T. Mutters
  • M. Sanguinetti
  • M. J. Schwaber
  • M. Souli
  • J. Torre-Cisneros
  • J. R. Price
  • J. Rodriguez-Bano

Scope: The aim of these guidelines is to provide recommendations for decolonizing regimens targeting multidrug-resistant Gram-negative bacteria (MDR-GNB) carriers in all settings.

Methods: These evidence-based guidelines were produced after a systematic review of published studies on decolonization interventions targeting the following MDR-GNB: third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE), carbapenem-resistant Enterobacteriaceae (CRE), aminoglycoside-resistant Enterobacteriaceae (AGRE), fluoroquinolone-resistant Enterobacteriaceae (FQRE), extremely drug-resistant Pseudomonas aeruginosa (XDRPA), carbapenem-resistant Acinetobacter baumannn (CRAB), cotrimoxazole-resistant Stenotrophomonas maltophilia (CRSM), colistin-resistant Gram-negative organisms (CoRGNB), and pan-drug-resistant Gram-negative organisms (PDRGNB). The recommendations are grouped by MDR-GNB species. Faecal microbiota transplantation has been discussed separately. Four types of outcomes were evaluated for each target MDR-GNB:(a) microbiological outcomes (carriage and eradication rates) at treatment end and at specific post-treatment time-points; (b) clinical outcomes (attributable and all-cause mortality and infection incidence) at the same time-points and length of hospital stay; (c) epidemiological outcomes (acquisition incidence, transmission and outbreaks); and (d) adverse events of decolonization (including resistance development). The level of evidence for and strength of each recommendation were defined according to the GRADE approach. Consensus of a multidisciplinary expert panel was reached through a nominal-group technique for the final list of recommendations.

Recommendations: The panel does not recommend routine decolonization of 3GCephRE and CRE carriers. Evidence is currently insufficient to provide recommendations for or against any intervention in patients colonized with AGRE, CoRGNB, CRAB, CRSM, FQRE, PDRGNB and XDRPA. On the basis of the limited evidence of increased risk of CRE infections in immunocompromised carriers, the panel suggests designing high-quality prospective clinical studies to assess the risk of CRE infections in immunocompromised patients. These trials should include monitoring of development of resistance to decolonizing agents during treatment using stool cultures and antimicrobial susceptibility results according to the EUCAST clinical breakpoints. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

Original languageEnglish
Pages (from-to)807-817
Number of pages11
JournalClinical Microbiology and Infection
Volume25
Issue number7
Publication statusPublished - Jul-2019

    Keywords

  • Acinetobacter, Carbapenemase, Decolonization, Enterobacteriaceae, Extended-spectrum beta-lactamase, Guideline, Multidrug-resistant, Gram-negative, Pseudomonas, Stenotrophomonas, FECAL MICROBIOTA TRANSPLANTATION, LACTAMASE-PRODUCING ENTEROBACTERIACEAE, SELECTIVE DIGESTIVE DECONTAMINATION, HIGH-RISK PATIENTS, INTENSIVE-CARE UNITS, KLEBSIELLA-PNEUMONIAE, ACINETOBACTER-BAUMANNII, TRACT DECONTAMINATION, COLISTIN RESISTANCE, ORAL GENTAMICIN

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