Title: Emergence of colistin-resistant Gram-negative Enterobacterales in the gut of patients receiving oral colistin and neomycin decontamination
Abstract: In this Journal, Zhu et al. recently reported the results of their genomic analysis of multidrug-resistant Klebsiella pneumoniae isolates from individual patients before and after colistin treatment highlighting the rapid emergence and multifaceted molecular mechanisms of colistin resistance in K. pneumoniae.1 Yan Z. Irene G. Ilias K. Jing L. Mon A.S. Jiayuan H. et al. Multifaceted mechanisms of colistin resistance revealed by genomic analysis of multidrug-resistant klebsiella pneumoniae isolates from individual patients before and after Colistin treatment. J Infect. 2019; 79: 312-321https://doi.org/10.1016/j.jinf.2019.07.009 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar This work highlights the therapeutic and public-health challenges of colistin-resistance (CR), which is increasingly used as a large resort antibiotic, despite its unattractive toxicity profile and narrow therapeutic window. 2 Jesús R.-B. Belén G.-G. Isabel M. Alvaro P. Treatment of infections caused by extended-spectrum-beta-lactamase-, AMPC-, and carbapenemase-producing enterobacteriaceae. Clin Microbiol Rev. 2018; 31https://doi.org/10.1128/CMR.00079-17 Crossref Scopus (347) Google Scholar Oral non-absorbed colistin has been proposed as a decontamination strategy in intensive care units and for patients carrying multidrug resistant Enterobacterales (MDR-E). 3 Benedikt H. Thomas H. Ilker Uçkay Gesuele R. Andrew S. Danièle S. et al. Decolonization of intestinal carriage of extended-spectrum β-lactamase-producing enterobacteriaceae with oral colistin and neomycin: a randomized, double-blind, placebo-controlled trial. J Antimicrob Chemother. 2013; 68: 2375-2382https://doi.org/10.1093/jac/dkt174 Crossref PubMed Scopus (71) Google Scholar ,4 de Smet A.M.G.A. Kluytmans J.A.J.W. Cooper B.S. Mascini E.M. Benus R.F.J. van der Werf T.S. et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009; 360: 20-31https://doi.org/10.1056/NEJMoa0800394 Crossref PubMed Scopus (601) Google Scholar The impact of decolonization strategies in terms of emergence of CR has rarely been monitored because no reliable selective medium existed and CR was not considered a public-health problem. Recently, reliable universal culture media have been developed to screen for CR. 5 Patrice N. Aurélie J. Laurent P. A universal culture medium for screening polymyxin-resistant gram-negative isolates. J Clin Microbiol. 2016; 54: 1395-1399https://doi.org/10.1128/JCM.00446-16 Crossref PubMed Scopus (72) Google Scholar