Proof-of-concept trial of the combination of lactitol with Bifidobacterium bifidum and Lactobacillus acidophilus for the eradication of intestinal OXA-48-producing Enterobacteriaceae

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

Genomics of Serratia marcescens isolates causing outbreaks in the same pediatric unit 47 years apart: Position in an updated phylogeny of the species

The first documented nosocomial outbreak caused by Serratia marcescens in Spain occurred in 1969 at the neonatal intensive care unit (NICU) of the tertiary La Paz Children’s Hospital in Madrid, Spain, and based on the available phenotyping techniques at this time, it was considered as a monoclonal outbreak. Only 47 years later, another S. marcescens outbreak of an equivalent dimension occurred at the same NICU. The aim of the present study was to study isolates from these historical and contemporary outbreaks by phenotypic analysis and whole-genome sequencing techniques and to position these strains along with 444 publicly available S. marcescens genomes, separately comparing core genome and accessory genome contents. Clades inferred by both approaches showed high correlation, indicating that core and accessory genomes seem to evolve in the same manner for S. marcescens. Nine S. marcescens clusters were identified, and isolates were grouped in two of them according to sampling year. One exception was isolate 13F-69, the most genetically distant strain, located in a different cluster. Categorical functions in the annotated accessory genes of both collections were preserved among all isolates. No significant differences in frequency of insertion sequences in historical (0.18–0.20)—excluding the outlier strain—versus contemporary isolates (0.11–0.19) were found despite the expected resting effect. The most dissimilar isolate, 13F-69, contains a highly preserved plasmid previously described in Bordetella bronchiseptica. This strain exhibited a few antibiotic resistance genes not resulting in a resistant phenotype, suggesting the value of gene down expression in adaptation to long-term starvation.CS was supported by “Fundación Mutua Madrileña” grant to RC achieved in 2017 call with reference number AP165902017. MP-A was supported by the Programa Operativo de Empleo Juvenil, cofinanced by the European Social Fund Investing in your future (ESF) and ERDF (PEJD-2018-PRE/BMD-8237). BP-V was funded by H2020 FTIPilot 2016 project no. 730713 “FAST-bact “A novel fast and automated test for antibiotic susceptibility testing for Gram positive and negative bacteria” and co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). FB was supported by grants from the Madrid Regional Government (InGEMICS-C; S2017/BMD-3691) and CIBER (CIBER in Epidemiology and Public Health, CIBERESP; CB06/02/0053), co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). This work was supported by the Instituto de Salud Carlos III, PI17/00115 (RC), and REIPI (RD16/0016/0011) actions, cofinanced by the European Development Regional Fund “A way to achieve Europe” (ERDF