Combating the spread of carbapenemases in Enterobacteriaceae: a battle that infection prevention should not lose

Savard, Patrice; Perl, Trish M.

doi:10.1111/1469-0691.12748

Cited by 47 publications

(40 citation statements)

References 59 publications

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“…Just as with ESBLs, there are likely community accelerators for spread. Hence, risk factors for colonisation and/or infection are the same as other drug-resistant organisms [12,13,35]. Long-term care settings, for example, are important reservoirs for community-onset, healthcare-associated transmission [37,50,51].…”

Section: Discussionmentioning

confidence: 99%

“…The high degree of variability in terms of geographical prevalence, isolate type and source, patterns of resistance and methods of study indicate a need for increased epidemiological surveillance. Many countries still lack nationwide surveillance [12]. Persons asymptomatically colonised with CRE present a potential reservoir for CAI and since the goal is to stop transmission, screening to identify high-risk individuals is important.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Kelly

Mathema

Larson

2017

International Journal of Antimicrobial Agents

187

141

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Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections, however carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6–10.8%. The presence of CRE in the community poses an urgent public health threat.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Kelly

Mathema

Larson

2017

International Journal of Antimicrobial Agents

187

141

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“…There was a decline of the nosocomial CRE acquisition from a monthly rate of 55.5 to an annual low of 4.8 cases per 100,000 patient-days (pG0.001) [107]. On the basis of several guidelines, rectal swab is the most common way to detect colonization, although no systematic comparative studies are performed so far to identify the most effective system to screen for KPC organism [108].…”

Section: Infection Control Measuresmentioning

confidence: 99%

Epidemiology and Treatment of MDR Enterobacteriaceae

Bassetti

Pecori

Sibani

et al. 2015

Curr Treat Options Infect Dis

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Opinion statementThe major progress in the history of medicine represented by the discovery of antibiotics is nowadays compromised by the universal spread of antibiotic resistance. World Health Organization (WHO) lists third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae and carbapenem-resistant K. pneumoniae in a group of seven bacteria of international concern, responsible for both healthcare-associated and community-acquired infections. Patients infected by these pathogens have limited therapeutic options, worse clinical outcomes, increased mortality rates, and a higher healthcare resources consumption. In infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, appropriate monotherapy is effective and carbapenems are the drugs of choice; however, β-lactams/β-lactamase inhibitors (BLBLIs) are regarded as an alternative mainly in patients without severe infections, with E. coli bacteremia with urinary source or with low minimum inhibitory concentrations (MICs). For infections caused by carbapenem-resistant Enterobacteriaceae (CRE), where the predicted mortality rate of patients is high, a combination antimicrobial treatment should be preferred. Many important variables in the treatment such as the role of high dosages and loading doses, the variable degrees of dosage reduction for impaired renal function, and the inclusion of carbapenems or tigecycline are a matter of debate. Despite the obscure vision provided by a notable number of meta-analyses, tigecycline is an effective and safe option for the treatment of MDR Enterobacteriaceae, as part of a combination regimen in case of infections caused by CRE, where a higher dosage (200 mg/daily) should be preferred. Colistin is the most active in vitro agent against CRE. Despite clinical data about the efficacy of fosfomycin against MDR Enterobacteriaceae are limited, this molecule represents an interesting option for the treatment of lower urinary tract and even systemic infections caused by difficult-to-treat Gram-negative pathogens. Based on in vitro studies, ceftolozane-tazobactam and ceftazidime-avibactam will represent very interesting new drugs for the treatment of ESBL-producing and CRE infections, respectively.

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“…In their recent review, P. Savard and T.M. Perl underlined the putative contribution of molecular techniques to screen CRE carriers directly from clinical samples [1]. The GenExpert® system (Cepheid, Sunnyvale, CA, USA) has developed a real-time PCR technique with ready-to use cartridges.…”

mentioning

confidence: 99%