Τίτλος:
ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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 baumannii (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. © 2019 The Authors
Συγγραφείς:
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.
Rodríguez-Baño, J.
Περιοδικό:
Clinical Microbiology and Infection
Λέξεις-κλειδιά:
all cause mortality; aminoglycoside resistant Enterobacteriaceae; bacterial colonization; carbapenem resistant Acinetobacter baumannii; carbapenem-resistant Enterobacteriaceae; cephalosporin resistant Enterobacteriaceae; colistin resistant Gram negative organism; cotrimoxazole resistant Stenotrophomonas maltophilia; Enterobacteriaceae; extremely drug resistant Pseudomonas aeruginosa; fecal microbiota transplantation; fluoroquinolone resistant Enterobacteriaceae; GRADE approach; Gram negative bacterium; hospitalization; human; length of stay; multidrug resistant Enterobacteriaceae; nonhuman; pan drug resistant Gram negative organism; priority journal; Short Survey; Acinetobacter baumannii; cross infection; drug effect; Europe; Gram negative bacterium; Gram negative infection; immunocompromised patient; multidrug resistance; practice guideline; Pseudomonas aeruginosa; Stenotrophomonas maltophilia, antiinfective agent, Acinetobacter baumannii; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Multiple, Bacterial; Europe; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Pseudomonas aeruginosa; Stenotrophomonas maltophilia
DOI:
10.1016/j.cmi.2019.01.005
