Probiotics for intestinal decolonization of ESBL-producing enterobacteriaceae; a randomized, placebo-controlled clinical trial

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Abstract

OBJECTIVES: Infections with extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (EPE) are a major healthcare concern. Our goal was to investigate whether a probiotic mixture could be used for eradication therapy in patients with prolonged intestinal EPE carriage.

METHODS: We performed a randomized, placebo-controlled single blinded clinical superiority trial in the south of Sweden between February 2017 and April 2019. Probiotic Vivomixx®, a mixture of 8 different living bacterial strains or placebo was given to adult outpatients intestinally colonized for at least three months with EPE. Patients with suspected active infections at the time of evaluation were excluded, immunosuppression, severe psychiatric disorder, drug abuse, or dementia. Each patient in the probiotic arm were administered 2 sachets (9.0 x 1011 live bacteria) twice daily for two months. The primary outcome was intestinal EPE eradication at the end of the one-year follow-up, as shown by three consecutive negative EPE rectal swabs during the follow-up year. The per protocol follow-up for all patients were 1, 3, 6 and 12 months after the initiation of the intervention. ClinicalTrials.gov Identifier: NCT03860415.

RESULTS: In total, the target size of 80 patients were included. The median age was 68 years in both groups. The number of females in the probiotics group were 23 (58 %) and in the placebo group 28 (70%). At the end of the trial, 12.5 % (5 out of 40) of the patients in the probiotic group had achieved successful eradication of EPE, as defined by the primary outcome, in the intention to treat analysis. In the placebo group, 5 % (2 out of 40) of the patients had achieved successful eradication of EPE (odds ratio 2,71; 95% confidence interval [CI], 0,49 to 14,9; p=0. 24).

CONCLUSIONS: Successful EPE eradication was observed in very few individualds. This trial did not support Vivomixx® as being superior to placebo for intestinal decolonization in adult patients with chronic colonization of EPE, but was limited in power.

Details

Authors
Organisations
External organisations
  • Helsingborg Hospital
  • Uppsala University
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Infectious Medicine
Original languageEnglish
JournalClinical Microbiology and Infection
Publication statusE-pub ahead of print - 2019 Sep 5
Publication categoryResearch
Peer-reviewedYes