Duration of carbapenemase-producing Enterobacteriales carriage among ICU patients in Miami, FL: A retrospective cohort study

Jiménez, Adriana; Fennie, Kristopher; Muñoz-Price, L. Silvia; Ibrahimou, Boubakari; Pekovic, Vukosava; Abbo, Lilian M.; Martínez, Octavio; Roselló, Gemma; Sposato, Kathleen; Doi, Yohei; Trepka, Mary Jo

doi:10.1016/j.ajic.2021.06.006

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…In the analysis of the effect of treatment on the outcome, we chose the ITR rather than the poor outcome rate as the study outcome because the sample sizes were too small to perform an adjusted analysis. The poor outcome rate is affected by many factors ( 16 , 17 ); however, the ITR is mainly affected by the type of bacteria ( 4 ), the treatment ( 18 ), and the presence of immunodeficiency ( 19 ). The treatment was the exposure factor, and we did not include any patients with immune system diseases in the study.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Kong

et al. 2022

Microbiol Spectr

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Carbapenem-resistant Gram-negative bacteria-related health care-associated ventriculitis and meningitis is a clinical threat because of the poor outcome and challenges in treatment. We reached several conclusions: (i) the antimicrobial resistance of pathogens is severe, and some antimicrobial agents represented by polymyxin are optional according to the antimicrobial susceptibility tests; (ii) in the background that the portion of carbapenems resistance in Gram-negative bacteria is increasing, there is no increasing trend for the antimicrobial resistance of carbapenem-resistant Gram-negative bacteria in the 9-year study; (iii) meropenem is the main antimicrobial agent in treatment, and trimethoprim-sulfamethoxazole, tigecycline, polymyxin, and meropenem/sulbactam are commonly used in the targeted treatment; (iv) the treatment effect was poor and affected by the treatment: timely active antimicrobial agents should be given.

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Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Kong

et al. 2022

Microbiol Spectr

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“…We assumed that uncolonised patients could also become colonised with CPE through the hospital environment at rate α = 0.00001 per day [23][24][25]. As CPE colonisation can persist for months [26], we assumed that patients who acquired CPE remained colonised during their hospital stay. The average length of stay (LOS) of uncolonised patients was set at 6 days.…”

Section: Assumptions and Parameters Of Modelmentioning

confidence: 99%

Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study

Kardaś-Słoma

Fournier²,

Dupont

et al. 2022

Antimicrob Resist Infect Control

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Background Spread of resistant bacteria causes severe morbidity and mortality. Stringent control measures can be expensive and disrupt hospital organization. In the present study, we assessed the effectiveness and cost-effectiveness of control strategies to prevent the spread of Carbapenemase-producing Enterobacterales (CPE) in a general hospital ward (GW). Methods A dynamic, stochastic model simulated the transmission of CPE by the hands of healthcare workers (HCWs) and the environment in a hypothetical 25-bed GW. Input parameters were based on published data; we assumed the prevalence at admission of 0.1%. 12 strategies were compared to the baseline (no control) and combined different prevention and control interventions: targeted or universal screening at admission (TS or US), contact precautions (CP), isolation in a single room, dedicated nursing staff (DNS) for carriers and weekly screening of contact patients (WSC). Time horizon was one year. Outcomes were the number of CPE acquisitions, costs, and incremental cost-effectiveness ratios (ICER). A hospital perspective was adopted to estimate costs, which included laboratory costs, single room, contact precautions, staff time, i.e. infection control nurse and/or dedicated nursing staff, and lost bed-days due to prolonged hospital stay of identified carriers. The model was calibrated on actual datasets. Sensitivity analyses were performed. Results The baseline scenario resulted in 0.93 CPE acquisitions/1000 admissions and costs 32,050 €/1000 admissions. All control strategies increased costs and improved the outcome. The efficiency frontier was represented by: (1) TS with DNS at a 17,407 €/avoided CPE case, (2) TS + DNS + WSC at a 30,700 €/avoided CPE case and (3) US + DNS + WSC at 181,472 €/avoided CPE case. Other strategies were dominated. Sensitivity analyses showed that TS + CP might be cost-effective if CPE carriers are identified upon admission or if the cases have a short hospital stay. However, CP were effective only when high level of compliance with hand hygiene was obtained. Conclusions Targeted screening at admission combined with DNS for identified CPE carriers with or without weekly screening were the most cost-effective options to limit the spread of CPE. These results support current recommendations from several high-income countries.

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“…L'exposition aux carbapénèmes semble associée à une colonisation prolongée (> 3 mois) par EPC (OR : 6,69 ; IC 95% : 1,96-22,85) 18 et certaines études retrouvent des résultats similaires. 12,20 Les autres facteurs influençant la durée de colonisation par EPC sont une immunosuppression, une ventilation mécanique, 19 la présence de matériel intraveineux, une faible activité fonctionnelle, 13 ainsi que des hospitalisations répétées. Entre 10 et 50 % des patients porteurs d'Enterobacteriaceae productrices de BLSE (E-BLSE) ou de carbapénémases (EPC) le sont encore à 1 année, probablement en raison de recontaminations lors d'expositions répétées.…”

Section: Facteurs Spécifiques Au Patientunclassified

Durée de colonisation digestive des [i]Enterobacteriaceae[/i] multirésistantes : connaissances actuelles

Calame¹,

Martischang²,

Harbarth³

2022

Revue Médicale Suisse

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La durée de colonisation digestive par les Enterobacteriaceae productrices de bêtalactamases à spectre élargi (E-BLSE) ou de carbapénèmases (EPC) a des répercussions sur le traitement empirique des cas connus et sur l'application des mesures de contrôle de l'infection. Toutefois, cette information reposant sur une évidence hétérogène est souvent surestimée, avec 10 à 50 % des porteurs colonisés à 1 an. L'utilisation de tests diagnostiques moléculaires est nécessaire pour distinguer les porteurs chroniques avérés des événements de recontamination. La durée médiane de colonisation parmi les porteurs d'E-BLSE est comprise entre 0,5 et 13 mois et, parmi les porteurs d'EPC, entre 0,7 et 10 mois. Nous proposons une revue narrative de la littérature sur le sujet, ainsi que quelques axes de réflexion future. Duration of enteric carriage of multiresistant Enterobacteriaceae: current state of the evidence Knowledge about the duration of digestive carriage of ESBL-and carbapenemase-producingEnterobacteriaceae is an essential information, impacting clinical decisions (empiric treatment for known carriers) and infection control measures (preemptive precautions, sequential screening). Ten to 50% carriers are still colonized after one year, but these numbers might be overestimated. Use of genomic typing is required to distinguish endogenous long-term carriage from exogenous recolonization events. Median length of colonization appears to range between 0,5 and 13 months for E-ESBL and 0,7 to 10 months for CPE. We performed a narrative review of the literature on this topic. We finally suggest a few future perspectives.

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Duration of carbapenemase-producing Enterobacteriales carriage among ICU patients in Miami, FL: A retrospective cohort study

Cited by 5 publications

References 25 publications

Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Carbapenem-Resistant Gram-Negative Bacteria-Related Healthcare-Associated Ventriculitis and Meningitis: Antimicrobial Resistance of the Pathogens, Treatment, and Outcome

Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study

Durée de colonisation digestive des [i]Enterobacteriaceae[/i] multirésistantes : connaissances actuelles

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