From the Guidelines
Management of patients with fecal carriage of colistin and carbapenem-resistant Gram-Negative Bacteria (GNBs) should prioritize infection prevention and control measures, including strict contact precautions, single-room isolation when possible, and enhanced hand hygiene compliance, as recommended by the most recent guidelines 1.
Key Strategies
- Implement bundle interventions including contact isolation of patients with CRGNB infections or colonization in hospital settings, as this has been shown to reduce the rate of CRGNB infections 1.
- Use single-room isolation when possible, and provide separate toilets for patients infected or colonized with CRGNB, to minimize the risk of transmission.
- Enhance hand hygiene compliance among healthcare workers, and ensure dedicated medical equipment is used for these patients to prevent cross-contamination.
- Perform active surveillance through rectal swabs to monitor colonization status, and consider decolonization strategies such as selective digestive decontamination using non-absorbable antibiotics.
Decolonization Strategies
- Consider using oral gentamicin (80mg QID) or oral colistin (2 million units QID) for 7-14 days, although evidence for their effectiveness remains limited 1.
- Fecal microbiota transplantation has shown promise in some cases, but is still considered experimental and requires further study.
Education and Training
- Educate healthcare workers about transmission prevention, and establish patient cohorts if multiple carriers are identified to prevent the spread of CRGNB within healthcare facilities.
Antibiotic Stewardship
- Restrict broad-spectrum antibiotics to prevent selection pressure, and consider combination therapy for CRAB infections, although the evidence for this approach is still limited 1.
Environmental Cleaning
- Intensify environmental cleaning with chlorhexidine or hydrogen peroxide-based disinfectants to reduce the risk of transmission. By prioritizing these strategies, healthcare facilities can reduce the risk of transmission and improve patient outcomes for those with fecal carriage of colistin and carbapenem-resistant GNBs.
From the Research
Management Strategies for Fecal Carriage of Colistin and Carbapenem-Resistant GNBs
- The management of patients with fecal carriage of colistin and carbapenem-resistant Gram-Negative Bacteria (GNBs) is a complex issue that requires a multifaceted approach 2, 3, 4, 5, 6.
- Infection Control Measures: Strict infection control measures, such as isolation cohorts and improved hygiene practices, are crucial in limiting the spread of resistant GNBs 3, 5.
- Antimicrobial Stewardship: The implementation of antimicrobial stewardship programs is essential in reducing the misuse and overuse of antibiotics, which can contribute to the development of resistance 5.
- Treatment Options: Treatment options for infections caused by colistin and carbapenem-resistant GNBs are limited, but certain antibiotics such as ceftazidime-avibactam and ceftolozane-tazobactam have shown promise in combating these resistant organisms 5.
- Monitoring and Surveillance: Active surveillance and monitoring of patients with fecal carriage of resistant GNBs are critical in detecting and preventing the spread of these organisms 3, 6.
- Novel Antibiotics: The development of novel antibiotics is necessary to combat the growing threat of colistin and carbapenem-resistant GNBs 5.
Key Considerations
- The gut may be a reservoir of resistant opportunistic bacteria, and the monitoring of carbapenem-resistant bacteria from inpatients' feces should be improved, especially for patients who have been using antibiotics for a long time 3.
- The coexistence of mcr-1 and blaNDM-1 in certain strains of GNBs has been reported, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms 3, 6.
- The use of colistin as a last-resort antibiotic has led to the emergence of colistin-resistant GNBs, emphasizing the need for alternative treatment options and strict antimicrobial stewardship 2, 5.