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. 2018 May 1;10(1):e2018030.
doi: 10.4084/MJHID.2018.030. eCollection 2018.

Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial

Igor Stoma  1 , Igor Karpov  1 , Igor Iskrov  2 , Svetlana Krivenko  2 , Anatoly Uss  2 , Svetlana Vlasenkova  2 , Irina Lendina  2 , Veronika Cherniak  2 , Dmitrii Suvorov  2
Affiliations

Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial

Igor Stoma et al. Mediterr J Hematol Infect Dis. .

Abstract

Background: Intestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies.

Objectives: The objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies.

Methods: In a tertiary hematology center, adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457.

Results: Short-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17-9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs. 12.9%), but overall in the 90-day observation period, it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed.

Conclusions: This study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects.

Keywords: Hematology; Multidrug-resistant bacteria; Neutropenia; Polymyxins; Selective oral decolonization.

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Conflict of interest statement

Competing interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1
Study flow diagram of the randomized controlled trial.
Figure 2
Figure 2
Evolution of rectal carriage of XDR/MDR Gram-negative bacteria over time with regard to decolonization with oral colistin in the study.
Figure 3
Figure 3
Probability of development of bloodstream infection in patients with intestinal colonization by MDR/XDR Gram-negative bacteria with regard to decolonization by oral colistin in the 90-day period after the intervention.
See this image and copyright information in PMC

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