Clinical Risk Factors and Microbiological and Intestinal Characteristics of Carbapenemase-Producing
            <i>Enterobacteriaceae</i>
            Colonization and Subsequent Infection

Yuan, Wei; Xu, Jiali; Guo, Lin; Chen, Yonghong; Gu, Jie; Zhang, Huan; Yang, Chenghang; Yang, Qiuping; Deng, Shuwen; Zhang, Longlong; Deng, Qiong-Fang; Wang, Zi; Ling, Bo; Deng, Di

doi:10.1128/spectrum.01906-21

Cited by 14 publications

(5 citation statements)

References 52 publications

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“…Among all colonized CR-GNB isolates, CRE colonization accounted for the highest, followed by CRPA, while CRAB colonization was rare. This was different from ICU patients, in whom CRKP and CRAB were the most commonly colonized pathogens ( 17 , 18 ). Moreover, metalloenzymes, especially NDM, produced in CRE isolated from patients with hematological diseases were significantly higher than the isolates separated from the whole population.…”

Section: Discussionmentioning

confidence: 65%

Risk factors and molecular epidemiology of intestinal colonization by carbapenem-resistant Gram-negative bacteria in patients with hematological diseases: a multicenter case‒control study

Hu,

Wang,

Sun

et al. 2024

Microbiol Spectr

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Patients with hematological diseases are considered to be at high risk for intestinal colonization by carbapenem-resistant Gram-negative bacteria (CR-GNB). However, the epidemiological data regarding risk factors and molecular characteristics of intestinal colonized CR-GNB isolates in this population are insufficient in China. A multicenter case‒control study involving 4,641 adult patients with hematological diseases from 92 hospitals across China was conducted. Following culture of collected rectal swabs, mass spectrometry and antimicrobial susceptibility tests were performed to identify GNB species and CR phenotype. Risk factors were assessed through retrospective clinical information. Whole-genome sequencing was used to analyze the molecular characteristics of CR-GNB isolates. This trial is registered with ClinicalTrials.gov as NCT05002582. Our results demonstrated that among 4,641 adult patients, 10.8% had intestinal colonization by CR-GNB. Of these, 8.1% were colonized by carbapenem-resistant Enterobacterales (CRE), 2.6% were colonized by carbapenem-resistant Pseudomonas aeruginosa (CRPA), and 0.3% were colonized by carbapenem-resistant Acinetobacter baumannii (CRAB). The risk factors for CR-GNB colonization include male gender, acute leukemia, hematopoietic stem cell transplantation, β-lactam antibiotic usage, and the presence of non-perianal infections within 1 week. Compared with CRPA-colonized patients, patients using carbapenems were more likely to be colonized with CRE. NDM was the predominant carbapenemase in colonized CRE. This study revealed a high CR-GNB intestinal colonization rate among adult patients with hematological diseases in China, with CRE being the predominant one. Notably, a significant proportion of CRE exhibited metallo-β-lactamase production, indicating a concerning trend. These findings emphasize the importance of active screening for CR-GNB colonization in patients with hematological diseases. IMPORTANCE Carbapenem-resistant Gram-negative bacteria (CR-GNB) has emerged as a significant threat to public health. Patients with hematological diseases are at high risk of CR-GNB infections due to their immunosuppressed state. CR-GNB colonization is an independent risk factor for subsequent infection. Understanding the risk factors and molecular characteristics of CR-GNB associated with intestinal colonization in patients with hematological diseases is crucial for empirical treatment, particularly in patients with febrile neutropenia. However, the epidemiology data are still insufficient, and our study aims to determine the intestinal colonization rate of CR-GNB, identify colonization risk factors, and analyze the molecular characteristics of colonized CR-GNB isolates.

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Section: Discussionmentioning

confidence: 65%

Risk factors and molecular epidemiology of intestinal colonization by carbapenem-resistant Gram-negative bacteria in patients with hematological diseases: a multicenter case‒control study

Hu,

Wang,

Sun

et al. 2024

Microbiol Spectr

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“…This data should be taken into account at Transplant Programs in order to adopt the best measures for minimizing CRE colonization. Indeed, multi-resistant bacterial colonization represents the major cause of mortality in patients receiving allogeneic HSCT for sepsis mainly in the early post-transplantation period [10]. The recent introduction of novel anti-MDR antibiotics is progressively changing the epidemiology and outcome of CRE infections.…”

Section: Discussionmentioning

confidence: 99%

“…While relevant advances have been made in the field [2,3], infection still remains one of the most severe and frequent complications of allo-HSCT [4][5][6]. The CRE colonization represents an important risk factor predisposing allo-HSCT recipients to severe sepsis, in particular during the aplasia period after the conditioning regimen [7][8][9][10]. Moreover, beyond the conditioning regimen intensity, local epidemiological factors, type of donor, stem cell source, grade of HLA matching and occurrence of complications such as Graft versus Host Disease (GvHD), are also relevant [11,12].…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Sars-Covid19 Pandemic on Multidrug Resistant Bacteria Colonization in Stem Cell Transplantation in the Era of New Agents

Picardi

2023

AICS

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Infections are among the major cause of mortality in patients receiving allogeneic hemopoietic stem cell transplantation (HSCT). In the last decades, the progressive raise of Carbapenemic Resistant Enterobacteriaceae (CRE) infections was associated with a concomitant increase in terms of morbidity and mortality rates. The primary aims of our retrospective analysis were to assess the impact of SARS-COVID19 Pandemic on CRE colonization at our Transplant Program and the efficacy of new antibiotics on the 100 days and 1-yr Transplant Related Mortality in both CRE colonized and non-colonized patients. CRE colonization resulted significantly lower during SARS-COVID19 Pandemic (p<0.0001), related to the COVID-19 associated restrictions adopted at the AORN Cardarelli Hospital, in Naples. However, the outcomes of CRE colonized and non-colonized patients who underwent allogeneic Hematopoietic Stem Cell Transplant procedure were similar in terms of morbidity and mortality (p=ns).

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“…Факторы, способствующие трансформации колони зации в инфекционный процесс, изучены недостаточно, однако есть указание на связь между степенью колони зирующей нагрузки и частотой развития инфекции, что наиболее вероятно происходит при селективном давле нии антибиотиков широкого спектра действия [33].…”

Section: Discussionunclassified

Carriage of K. pneumoniae and molecular structure of produced carbapenemases in infants with congenital heart defects

Popov,

Osokina,

Vostrikova

2023

CMAC

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Objective. To evaluate frequency of pharyngeal and rectal mucosa colonization by K. pneumoniae strains in infants with congenital heart defects at the stage of cardiosurgical hospital admission, as well as dynamic analysis of production frequency and molecular structure of K. pneumoniae carbapenemases. Materials and Methods. A total of 1445 patients with risk factors (antibiotic therapy in the anamnesis, emergency hospitalization, transfer from other hospitals) admitted for surgical treatment of congenital heart defects (CHDs) between January 1, 2020 and December 31, 2022 were included in the retrospective analysis. Median age was 1.08 months (between 0 and 12 months). Smears from the pharyngeal and rectal mucosa (2890 samples) were taken for microbiological examination no later than 72 h after admission. The isolation of extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases producing K. pneumoniae in the absence of symptomatic infection was considered as colonization. K. pneumoniae strains were considered as «problematic» in the absence of susceptibility to three or more groups of antimicrobials: the third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides. The profile of antibiotic resistance, carbapenemases production and their molecular type were determined in the isolated strains. Results. K. pneumoniae carriage with «problematic» sensitivity was detected in 252 out of 1445 (17.4%) patients: 153 out of 1445 (10.6%) children were colonized by only ESBLs producers, and 99 out of 1445 (6.9%) children – by both ESBLs and carbapenemases producers. In dynamics, the number of ESBLs producers carriers decreased by 1.5 times (50 out of 448 – 11.2% and 37 out of 506 – 7.3% in 2020 and 2022, respectively). The number of K. pneumoniae producing both ESBLs and carbapenemases carriers increased by 4.9 times (11 out of 448 – 2.5% and 62 out og\f 506 – 12.3% in 2020 and 2022, respectively), in 2022 exceeding the proportion of only ESBLs producers carriers by 1.7 times. The molecular structure of carbapenemases was represented by OXA-48 carbapenemases (44 out of 99 – 44.5%), NDM metalloenzymes (35 out of 99 – 35.4%), OXA-48 and NDM combinations (13 out of 99 – 13.1%), KPC (3 out of 99 – 3%), NDM, KPC and OXA-48, NDM and KPC combinations: 3 out of 99 – 3% and 1 out of 99 – 1% of carriers, respectively. In dynamics, the number of isolates with the production of OXA-48 carbapenemases increased by 34.8% (from 18.2% to 53% in 2020 and 2022, respectively), NDM carbapenemases and co-producers of OXA-48, NDM decreased by 25.9% (from 54.5% to 28.6% in 2020 and 2022) and 19.1% (from 27.3% to 8.2% in 2020 and in 2022), respectively. In 2022, strains with the production of KPC carbapenemases and co-producers of carbapenemases of three classes (OXA-48, NDM and KPC) were identified for the first time. Conclusions. The data obtained indicate an increase in the frequency of initial colonization of patients with carbapenem-resistant K. pneumoniae, an expansion of the structure of carbapenemases produced by them, that, if infection control measures are not followed, can increase the frequency of infections caused by them.

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Clinical Risk Factors and Microbiological and Intestinal Characteristics of Carbapenemase-Producing Enterobacteriaceae Colonization and Subsequent Infection

Cited by 14 publications

References 52 publications

Risk factors and molecular epidemiology of intestinal colonization by carbapenem-resistant Gram-negative bacteria in patients with hematological diseases: a multicenter case‒control study

Risk factors and molecular epidemiology of intestinal colonization by carbapenem-resistant Gram-negative bacteria in patients with hematological diseases: a multicenter case‒control study

The Impact of the Sars-Covid19 Pandemic on Multidrug Resistant Bacteria Colonization in Stem Cell Transplantation in the Era of New Agents

Carriage of K. pneumoniae and molecular structure of produced carbapenemases in infants with congenital heart defects

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