Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE), a major resistance concern emerging during the last decade because of significantly compromising the efficacy of carbapenem agents, has currently become an important focus of infection control. Many investigations have shown a high association of CRE infections with high case-fatality rates. In Taiwan, a few surveys observed that a significant proportion (29–47%) of the CR-Klebsiella pneumoniae isolates harbored a plasmidic allele encoding K. pneumoniae carbapenemases (KPC, especially KPC-2). A significant increase in the number of oxacillinase (OXA)-48-like carbapenemases among CR-K. pneumoniae isolates was observed between 2012 and 2015. By striking contrast, isolates of CR-Escherichia coli and CR-Enterobacter species in Taiwan had a much lower percentage of carbapenemase production than CR-K. pneumoniae isolates. This differs from isolates found in China as well as in the India subcontinent. Apart from the hospital setting, CRE was also cultured from the inpatients from communities or long-term care facilities (LTCF). Therefore, implementation of regular CRE screening of LTCF residents, strict disinfectant use in nursing homes and hospital settings, and appropriate control of antibiotic prescriptions is suggested to alleviate the spread of clinical CRE isolates in Taiwan. Although there are some promising new antibiotics against CRE, such as ceftazidime-avibactam, meropenem-vaborbactam, aztreonam-avibactam and cefiderocol, these agents are not available in Taiwan currently. Therefore, in order to effectively decrease case-fatality rates among patients with the infections owing to carbapenemase-producing CRE isolates, combination antibiotic schemes, including colistin (or amikacin) and/or tigecycline in combination with an anti-pseudomonal carbapenem agent, remain the mainstay for treating clinical CRE infections.

Colonization With Multidrug-Resistant Organisms Among Healthy Adults in the Community Setting: Prevalence, Risk Factors, and Composition of Gut Microbiome

“…One study from India reported no urine colonization of imipenem-or meropenem-resistant Enterobacteriaceae in 433 healthy individuals (Lohiya et al, 2015). In our study, we did not find VRE or CRE colonization among healthy adults, despite the increased prevalence of both pathogens in hospitals in Taiwan (Wang et al, 2013;Jean et al, 2018). Our results suggest that in the community, the spread of VRE or CRE occurs mainly in health care facilities such as nursing homes (Lee et al, 2017).…”

<p>Evaluation of Resistance Mechanisms in Carbapenem-Resistant <em>Enterobacteriaceae</em></p>

“…The increase in CRE is a serious matter due to high case-fatality rates (>30%). [24][25][26] Studying the mechanisms of CRE is an essential step in planning a national public health strategy for this emerging pathogen. 27 Several studies have been studied the mechanisms of resistance to carbapenem in CRE isolates from Iran.…”

Evaluation of MASTDISCS combi Carba plus for the identification of metallo‐β‐lactamases, KPC and OXA‐48 carbapenemase genes in Enterobacteriaceae clinical isolates

“…Carbapenems are often considered last resort antibiotics in the treatment of infections due to multidrug-resistant Enterobacteriaceae clinical isolates, since they are stable even in response to extended-spectrum b-lactamases (ESBLs) and AmpC enzymes (Tsakris et al 2010;Jean et al 2018;Carrasco-Anabal on et al 2019;Wang et al 2019). However, the carbapenem resistance has been increasingly reported among Enterobacteriaceae in the past few years, which is largely attributed to the production of metallo-b-lactamases (MBLs), KPC and OXA-48 (Yusuf et al 2014;Tijet et al 2016;No€ el et al 2017;Tamma and Simner 2018).…”