Lambelet Paola, Tascini Carlo, Fortunato Simona, Stefanelli Alessandro, Simonetti Federico, Vettori Chiara, Leonildi Alessandro, Menichetti Francesco
Unico della Versilia Hospital, Hematology, Camaiore Lucca, Italy.
Cotugno Hospital, First Infectious Diseases Unit, Naples, IT.
New Microbiol. 2017 Jul;40(3):161-164. Epub 2017 May 17.
The mortality for carbapenem-resistant Klebsiella pneumoniae (KPC-Kp) infection ranges from 18 to 48% depending on the type of therapy. Mortality rates in hematologic patients are even higher, up to 85%. Gut decontamination with oral gentamicin might be an option to avoid a subsequent KPC-Kp infection in colonized patients. We treated 14 hematologic patients with oral gentamicin, 80 mg four times daily, for 7 to 25 days in order to eradicate KPC-Kp from the gut, starting oral gentamicin therapy when possible after the discontinuation of systemic antibiotic therapy. The overall decontamination rate in the entire study population was 71% (10/14). Out of the 4 patients who did not respond to oral gentamicin therapy, 1 KPC-Kp strain was gentamicin resistant and 4 patients received concomitant systemic antibiotic therapy (CSAT). One of these patients died from KPC-Kp sepsis. The decontamination rate was 90% (9/10) in patients receiving oral gentamicin only, versus 25% (1/4) in those also treated with CSAT. No new gentamicin-resistant KPC-Kp strain was isolated during oral gentamicin therapy Oral gentamicin might be useful for gut decontamination and prevention of KPC-Kp infection. This option should be considered in patients colonized by a gentamicin-susceptible KPC-Kp strain and not receiving CSAT.
耐碳青霉烯类肺炎克雷伯菌（KPC-Kp）感染的死亡率因治疗方式而异，在18%至48%之间。血液系统疾病患者的死亡率甚至更高，可达85%。口服庆大霉素进行肠道去污可能是避免定植患者后续发生KPC-Kp感染的一种选择。我们对14例血液系统疾病患者给予口服庆大霉素治疗，每日4次，每次80mg，疗程7至25天，以清除肠道内的KPC-Kp，在全身抗生素治疗停药后尽可能早地开始口服庆大霉素治疗。整个研究人群的总体去污率为71%（10/14）。在4例对口服庆大霉素治疗无反应的患者中，1株KPC-Kp菌株对庆大霉素耐药，4例患者接受了全身性抗生素联合治疗（CSAT）。其中1例患者死于KPC-Kp败血症。仅接受口服庆大霉素治疗的患者去污率为90%（9/10），而接受CSAT治疗的患者去污率为25%（1/4）。口服庆大霉素治疗期间未分离出新的耐庆大霉素KPC-Kp菌株。口服庆大霉素可能有助于肠道去污和预防KPC-Kp感染。对于定植有对庆大霉素敏感的KPC-Kp菌株且未接受CSAT治疗的患者，应考虑这一选择。
