AI Article Synopsis

  • Haematological patients undergoing chemotherapy are at an increased risk for bloodstream infections (BSI) caused by ESBL-E bacteria, prompting this study to explore selective digestive decontamination (SDD) as a preventive measure.
  • A stochastic simulation model was created to analyze the effects of targeted SDD versus a placebo on the incidence of ESBL-E BSI among patients, taking various factors like prevalence of colonization and neutropenia duration into account.
  • Results indicated that targeted SDD could potentially reduce ESBL-E BSI incidence by up to 27%, especially in high-prevalence situations, while showing limited effectiveness in low-prevalence environments.

Article Abstract

Introduction: Haematological patients are at higher risk of bloodstream infections (BSI) after chemotherapy. The aim of this study was to develop a simulation model assessing the impact of selective digestive decontamination (SDD) of haematological patients colonised with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) on the incidence of ESBL-E BSI after chemotherapy.

Methods: A patient population was created by a stochastic simulation model mimicking the patients' states of colonisation with ESBL-E during hospitalisation. A systematic literature search was performed to inform the model. All ESBL-E carriers were randomised (1:1) to either the intervention (targeted SDD) or the control group (placebo). ESBL-E BSI incidence was the outcome of the model. Sensitivity analyses were performed by prevalence of ESBL-E carriage at hospital admission (low: < 10%, medium: 10-25%, high: > 25%), duration of neutropenia after receiving chemotherapy, administration of antibiotic prophylaxis with quinolones, and time interval between SDD and chemotherapy.

Results: The model estimated that the administration of targeted SDD before chemotherapy reduces the incidence of ESBL-E BSI in the hospitalised haematological population up to 27%. The greatest benefit was estimated in high-prevalence settings, regardless of the duration of neutropenia, the time interval before chemotherapy, and the administration of antibiotic prophylaxis with quinolones (p < 0.05). In medium-prevalence settings, SDD was effective in patients receiving quinolone prophylaxis, with either 1-day time interval before chemotherapy and a neutropenia duration > 6 days (p < 0.05) or 7-day time interval before chemotherapy and a neutropenia duration > 9 days (p < 0.05). No benefit was observed in low-prevalence settings.

Conclusions: Our model suggests that targeted SDD could decrease the rate of ESBL-E BSI in haematological carriers before chemotherapy in the setting of high ESBL-E prevalence at hospital admission. These estimates require confirmation by well-designed multicentre RCTs, including the assessment of the impact on resistance/disruption patterns of gut microbiome.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847524PMC
http://dx.doi.org/10.1007/s40121-021-00550-3DOI Listing

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