Act Fast as Time Is Less: High Faecal Carriage of CarbapenemResistant Enterobacteriaceae in Critical Care Patients

Saseedharan, Sanjith; Sahu, Manisa; Pathrose, Edwin; Shivdas, Sarita

doi:10.7860/jcdr/2016/17638.8400

Cited by 10 publications

(10 citation statements)

References 28 publications

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“… 15 However, few studies have emerged from the subcontinent highlighting the burden and the impact of CRE. 5 , 16 , 17 Despite recognition of CRE as a global public health threat, the study on the acquisition and the natural history of colonisation with CRE in patients with various HM remain sparse. A review in 2014 by Satlin et al identified six studies reporting 35 patients of HM and HSCT in total, with a mortality rate of 50–100%.…”

Section: Discussionmentioning

confidence: 99%

“… 2 The increasing incidence of infection by carbapenem-resistant enterobacteriaceae (CRE) is a significant public health challenge worldwide, especially in the developing countries. 3 – 5 It has acutely exposed the limitations of our antibiotics armamentarium. 6 Patients with haematological malignancies (HM) and the recipients of hematopoietic stem cell transplantation (HSCT) are particularly vulnerable to infections with CRE.…”

Section: Introductionmentioning

confidence: 99%

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Gut Colonization With Carbapenem Resistant Enterobacteriaceae Adversely Impacts the Outcome in Patients With Hematological Malignancies: Results of a Prospective Surveillance Study

Chakrabarti

2018

Mediterr J Hematol Infect Dis

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BackgroundGut colonisation with carbapenem-resistant enterobacteriaceae (CRE) is a risk factor for CRE bacteremia and patients with haematological malignancies (HM) are at the highest risk of mortality.MethodsWe conducted a prospective surveillance study of gut colonisation with CRE and its impact on the outcome of 225 consecutive patients of HM over 28 months.ResultsThe median age of the cohort was 46 years, the majority with acute leukaemia. 48 (21%) patients were colonised with CRE on admission (CAD). Another 46 patients were colonised with CRE in the hospital (CIH). The risk factors for CAD and CIH were a diagnosis of acute leukaemia and duration of hospital stay respectively. CRE accounted for 77% of infection-related mortality (IRM). The incidence of CRE bacteremia in CRE positive patients was 18% (17/94), and mortality in those with CRE bacteremia was 100%. IRM was 35.3% in CIH group compared to 10.5% in the CAD group (p=0.0001). IRM was highest in those with acute myeloid leukaemia (AML) and CIH (54.9% p=0.0001). On multivariate analysis, CIH was the most important risk factor for IRM (HR-7.2).ConclusionOur data demonstrate that a substantial proportion of patients with HM are colonised with CRE without prior hospitalisation, but those with nosocomial colonisation have the highest risk of mortality, particularly in those with AML.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gut Colonization With Carbapenem Resistant Enterobacteriaceae Adversely Impacts the Outcome in Patients With Hematological Malignancies: Results of a Prospective Surveillance Study

Chakrabarti

2018

Mediterr J Hematol Infect Dis

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“…This study also showed a high level of sensitivity of CRE isolates to colistin and tigecycline. 24 On a global level, gastrointestinal carriage rate of CRE has been shown to be highly variable. Prevalence of CPE carriers admitted to ICUs in 11 acute care Spanish hospitals was 1.6% to 2.4%.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of carbapenem-resistant Enterobacteriaceae colonization in ICU: a pilot study from a tertiary care hospital in Western Rajasthan, India

Rajni¹,

Rajpurohit

Rathore

et al. 2018

Int J Res Med Sci

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Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a serious global public health threat. Antibiotic overuse, improper sanitation and unhygienic practices lead to large scale carriage and rapid spread.Methods: This is a prospective hospital based study planned for a period of 3 months including all patients admitted to 14 bedded Trauma ICU of a tertiary care hospital in Rajasthan. Rectal swabs were collected from admitted patients and carriage of carbapenem resistant Enterobacteriaceae looked for as per CDC guidelines. Screening of the Enterobacteriaceae colonies for carbapenemase production was done by Modified Hodge test. Carbapenem-resistant isolates were also tested for Metallo beta lactamase production by phenotypic disc confirmatory test.Results: A total of 73 patients were screened and 27 CRE isolates were obtained, carriage rate being 37%. A high level of resistance was seen to aminoglycosides, fluoroquinolones and cephalosporins. 100% sensitivity was however seen to Colistin, Tigecycline and Fosfomycin. 5 out of 27 strains showed a positive MHT test. Metallo beta lactamase (MBL) production was seen in 21/25 strains as tested by meropenem and Meropenem-EDTA discs.Conclusions: The current pilot study finds out the prevalence of CRE carriage among critically ill patients and stresses upon strong need for stringent infection control measures.

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“…The most important risk factor associated with condition is a previous history of antibiotic intake within the past 3 months, previous hospital admission, etc., The earlier study from various hospitals of India showed a varied incidence of CRE ranges from 1.8% to 51% in different patient population. [6] The first Indian study among the pediatric cancer patients had reported the prevalence of CRE colonization as 20.2%. [10] In the current study, the incidence of CRE has been observed much higher which should be considered seriously.…”

Section: Discussionmentioning

confidence: 99%

“…There is paucity of data available on the prevalence of CRE in India. [456] To date, only one study is available exhibiting the prevalence of the colonization rate of multidrug-resistant organism and CRE among pediatric cancer patients. Hence, we carried out a prospective study to determine the incidence of rectal carriage of CRE in patients with hematological malignancy.…”

Section: Introductionmentioning

confidence: 99%

Rectal carriage of carbapenem-resistant enterobacteriaceae: A menace to highly vulnerable patients

Kumar

Mohapatra

Bakhshi

et al. 2018

J Global Infect Dis

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Background:Bloodstream infection (BSI) due to carbapenem-resistant enterobacteriaceae (CRE) is the leading cause of morbidity and mortality in patients with hematological malignancy. These patients receive chemotherapy during treatment, which lead to severe mucositis of gastrointestinal tract and myelosuppression. It was hypothesized that the gut colonizer translocate into the blood circulation causing BSI. Colonization rate with CRE among these patients in India is unknown.Aim:This study aims to determine the carriage rate of CRE in cancer patients.Setting and Design:A prospective study was conducted in a tertiary care hospital of India.Materials and Methods:Rectal swab of 93 patients were collected and processed as per the Center for Disease Control and Prevention protocol for detection of CRE. The isolate CREs were identified by standard phenotypic tests and confirmed for carbapenem resistance by disk diffusion test using carbapenem disk (imipenem, meropenem, doripenem, and ertapenem), Carba-NP test and modified Hodge test. Resistant to any of the carbapenem disc is considered as CRE.Results:A total of 86 isolates were detected from 93 patients. Seventy-six isolates were identified as CRE, and 10 isolates were Gram-positive cocci and other Gram-negative bacilli. Acute myeloid leukemia was the most common clinical presentation followed by acute lymphoid leukemia. Thirty-nine out of 93 patients were on chemotherapy. Sixty-seven out of 76 isolates of CRE were observed positive for carbapenemase production by Carba-NP test.Conclusion:This study highlights very high rate of CRE carriage among the hematological malignancy patients; who are highly vulnerable to infection. This confirms the need of infection control prevention activities among the hematological malignancy patients.

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Act Fast as Time Is Less: High Faecal Carriage of CarbapenemResistant Enterobacteriaceae in Critical Care Patients

Cited by 10 publications

References 28 publications

Gut Colonization With Carbapenem Resistant Enterobacteriaceae Adversely Impacts the Outcome in Patients With Hematological Malignancies: Results of a Prospective Surveillance Study

Gut Colonization With Carbapenem Resistant Enterobacteriaceae Adversely Impacts the Outcome in Patients With Hematological Malignancies: Results of a Prospective Surveillance Study

Epidemiology of carbapenem-resistant Enterobacteriaceae colonization in ICU: a pilot study from a tertiary care hospital in Western Rajasthan, India

Rectal carriage of carbapenem-resistant enterobacteriaceae: A menace to highly vulnerable patients

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