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European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Mar, 2023;42 (3): 229-254.

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers.

Edgar I Campos-Madueno, Melika Moradi, Yasmine Eddoubaji, Fatemeh Shahi, Sina Moradi, Odette J Bernasconi, Aline I Moser, Andrea Endimiani
Author Information
  1. Edgar I Campos-Madueno: Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
  2. Melika Moradi: Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  3. Yasmine Eddoubaji: Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
  4. Fatemeh Shahi: Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  5. Sina Moradi: Department of Computer Engineering and Information Technology, Islamic Azad University Tehran Central Branch, Tehran, Iran.
  6. Odette J Bernasconi: Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
  7. Aline I Moser: Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
  8. Andrea Endimiani: Institute for Infectious Diseases, University of Bern, Bern, Switzerland. andrea.endimiani@unibe.ch. ORCID
PMID: 36680641 DOI: 10.1007/s10096-023-04548-2

Abstract

The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens-especially Escherichia coli and Klebsiella pneumoniae-may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.

Keywords

Bacteriophages ESBL FMT Microcins Probiotics SDD

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Grants

  1. 192514/Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
  2. 206400/Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung

MeSH Term

Humans
Drug Resistance, Multiple, Bacterial
beta-Lactamases
Klebsiella pneumoniae
Escherichia coli
Fecal Microbiota Transplantation
Risk Factors
Gammaproteobacteria
Anti-Bacterial Agents

Chemicals

beta-Lactamases
Anti-Bacterial Agents
Journal Article Review
Article has an altmetric score of 6

Word Cloud

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