Proof-of-concept trial of the combination of lactitol with Bifidobacterium bifidum and Lactobacillus acidophilus for the eradication of intestinal OXA-48-producing Enterobacteriaceae
Juan Carlos Ramos-Ramos,
Fernando Lázaro-Perona,
José Ramón Arribas,
Julio García-Rodríguez,
Jesús Mingorance,
Guillermo Ruiz-Carrascoso,
Alberto M. Borobia,
José Ramón Paño-Pardo,
Rafael Herruzo,
Francisco Arnalich
Affiliations
Juan Carlos Ramos-Ramos
Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz
Fernando Lázaro-Perona
Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz
José Ramón Arribas
Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz
Julio García-Rodríguez
Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz
Jesús Mingorance
Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz
Guillermo Ruiz-Carrascoso
Servicio de Microbiología, Hospital Universitario La Paz, IdiPaz
Alberto M. Borobia
Departamento de Farmacología Clínica, Hospital Universitario La Paz
José Ramón Paño-Pardo
Unidad de Microbiología Clínica y Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz
Rafael Herruzo
Servicio de Medicina Preventiva, Hospital Universitario La Paz
Francisco Arnalich
Servicio de Medicina Interna, Hospital Universitario La Paz
Abstract Background The major reservoir of carbapenemase-producing Enterobacteriaceae (CPE) is the gastrointestinal tract of colonized patients. Colonization is silent and may last for months, but the risk of infection by CPE in colonized patients is significant. Methods Eight long-term intestinal carriers of OXA-48-producing Enterobacteriaceae (OXA-PE) were treated during 3 weeks with daily oral lactitol (Emportal®), Bifidobacterium bifidum and Lactobacillus acidophilus (Infloran®). Weekly stool samples were collected during the treatment period and 6 weeks later. The presence of OXA-PE was investigated by microbiological cultures and qPCR. Results At the end of treatment (EoT, secondary endpoint 1), four of the subjects had negative OXA-PE cultures. Three weeks later (secondary endpoint 2), six subjects were negative. Six weeks after the EoT (primary endpoint), three subjects had negative OXA-PE cultures. The relative intestinal load of OXA-PE decreased in all the patients during treatment. Conclusions The combination of prebiotics and probiotics was well tolerated. A rapid reduction on the OXA-PE intestinal loads was observed. At the EoT, decolonization was achieved in three patients. Clinical Trials Registration: NCT02307383. EudraCT Number: 2014-000449-65.