Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae

Martirosov, Dmitriy M.; Lodise, Thomas P.

doi:10.1016/j.diagmicrobio.2015.10.008

Cited by 45 publications

(32 citation statements)

References 71 publications

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“…Long-term care facility residence was not related to CRE acquisition; however, regular visits to the outpatient clinic was a risk factor for CRE acquisition in CSE group I in our study. Insertion of medical instruments is also a known risk factor for CRE infections [ 34 ]. Severely ill patients, such as those undergoing mechanical ventilation, intensive treatment, and transplantation, or those with a lengthy prior hospital stay and course of antibiotics use are at risk for acquiring CRE infection, as reported by a matched case-control study [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-resistantEnterobacteriaceae: Prevalence and Risk Factors in a Single Community-Based Hospital in Korea

et al. 2016

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BackgroundCarbapenemase-producing Enterobacteriaceae (CPE) are Gram-negative bacteria with increasing prevalence of infection worldwide. In Korea, 25 cases of CPE isolates were reported by the Korea Centers for Disease Control and Prevention in 2011. Most CPE cases were detected mainly at tertiary referral hospitals. We analyzed the prevalence and risk factors for carbapenem-resistant Enterobacteriaceae (CRE) in a mid-sized community-based hospital in Korea.Materials and MethodsWe retrospectively analyzed all consecutive episodes of Enterobacteriaceae in a mid-sized community-based hospital from January 2013 to February 2014. CRE was defined as organisms of Enterobacteriaceae showing decreased susceptibility to carbapenems. Risk factors for CRE were evaluated by a case–double control design. Carbapenemase was confirmed for CRE using a combined disc test.ResultsDuring 229,710 patient-days, 2,510 Enterobacteriaceae isolates were obtained. A total of 41 (1.6%) CRE isolates were enrolled in the study period. Thirteen species (31.7%) were Enterobacter aerogenes, 8 (19.5%) Klebsiella pneumoniae, 5 (12.2%) Enterobacter cloacae, and 15 other species of Enterobacteriaceae, respectively. Among the 41 isolates, only one (2.4%) E. aerogenes isolate belonged to CPE. For evaluation of risk factors, a total of 111 patients were enrolled and this included 37 patients in the CRE group, 37 in control group I (identical species), and 37 in control group II (different species). Based on multivariate analysis, regularly visiting the outpatient clinic was a risk factor for CRE acquisition in the control group I (P = 0.003), while vascular catheter and Charlson comorbidity index score ≥ 3 were risk factors in control group II (P = 0.010 and 0.011, each). Patients with CRE were more likely to experience a reduced level of consciousness, use a vasopressor, be under intensive care, and suffer from acute kidney injury. However, CRE was not an independent predictor of mortality compared with both control groups.ConclusionIn conclusion, the prevalence of CRE was higher than expected in a mid-sized community-based hospital in Korea. CRE should be considered when patients have a vascular catheter, high comorbidity score, and regular visits to the outpatient clinic. This study suggests the need for appropriate prevention efforts and constant attention to CRE infection control in a mid-sized community-based hospital.

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Section: Discussionmentioning

confidence: 99%

Carbapenem-resistantEnterobacteriaceae: Prevalence and Risk Factors in a Single Community-Based Hospital in Korea

et al. 2016

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“…Vancomycin and teicoplanin strongly suppressed Gram-positive bacterial infections. Thus far, carbapenems represent the last line of treatments of multidrug-resistant Gram-negative pathogens in empirical treatment 27 . However, various studies have reported that carbapenems are associated with severe nephrotoxicity and ototoxicity, and excessive use of carbapenems may promote the prevalence of pathogens resistant to these drugs, resulting in serious outcomes 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis

Xie

Tang

et al. 2017

Sci Rep

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Bloodstream infections (BSIs) are a frequently observed complication in liver cirrhosis patients. This study aimed to investigate the microbiological characteristics and outcomes of BSIs in patients with liver cirrhosis. We retrospectively studied 852 patients with liver cirrhosis who developed a BSI. Patient outcome was evaluated using 30-day mortality and assessed using multivariate stepwise logistic regression analysis. Antibiotic sensitivity of the pathogens was tested. Gram-negative bacteria were responsible for 59.6% of BSIs, and Gram-positive bacteria caused 40.4% of the episodes among liver cirrhosis patients. The bacterial distribution significantly differed between hospital-acquired and community-acquired infections, especially in cases caused by Gram-negative pathogens. The results of the drug sensitivity test suggested that amikacin, cefoperazone/sulbactam, and piperacillin/tazobactam highly suppressed Gram-negative infections, while vancomycin and teicoplanin strongly inhibited Gram-positive BSIs. Liver failure, liver cancer, complications, Child-Pugh grade, septic shock, administration of appropriate antibiotics within 24 h, ICU admission, nosocomial infection, and Gram nature of the bacteria were independent risk factors for 30-day mortality (P < 0.05). The choice of initial empirical antibiotics should be based on the type, severity and origin of infection and on the local epidemiological data on antibiotic resistance. Accurate evaluation of risk factors for mortality may improve appropriate therapeutic choice.

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“…Eravacycline is a novel synthetic fluorotetracycline with potency that is 2-to 4-fold higher than that of tigecycline in NDM-positive strains. In an in vitro analysis of 2,644 Gram-negative pathogens, eravacycline demonstrated excellent activity against 18 E. coli strains that had carbapenem resistance associated with OXA and NDM (281). Eravacycline was approved for treating adults with complicated intra-abdominal infections by the FDA in August 2018.…”

Section: Eravacyclinementioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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SUMMARYNew Delhi metallo-β-lactamase (NDM) is a metallo-β-lactamase able to hydrolyze almost all β-lactams. Twenty-four NDM variants have been identified in >60 species of 11 bacterial families, and several variants have enhanced carbapenemase activity.Klebsiella pneumoniaeandEscherichia coliare the predominant carriers ofblaNDM, with certain sequence types (STs) (forK. pneumoniae, ST11, ST14, ST15, or ST147; forE. coli, ST167, ST410, or ST617) being the most prevalent. NDM-positive strains have been identified worldwide, with the highest prevalence in the Indian subcontinent, the Middle East, and the Balkans. MostblaNDM-carrying plasmids belong to limited replicon types (IncX3, IncFII, or IncC). Commonly used phenotypic tests cannot specifically identify NDM. Lateral flow immunoassays specifically detect NDM, and molecular approaches remain the reference methods for detectingblaNDM. Polymyxins combined with other agents remain the mainstream options of antimicrobial treatment. Compounds able to inhibit NDM have been found, but none have been approved for clinical use. Outbreaks caused by NDM-positive strains have been reported worldwide, attributable to sources such as contaminated devices. Evidence-based guidelines on prevention and control of carbapenem-resistant Gram-negative bacteria are available, although none are specific for NDM-positive strains. NDM will remain a severe challenge in health care settings, and more studies on appropriate countermeasures are required.

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Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae

Cited by 45 publications

References 71 publications

Carbapenem-resistantEnterobacteriaceae: Prevalence and Risk Factors in a Single Community-Based Hospital in Korea

Carbapenem-resistantEnterobacteriaceae: Prevalence and Risk Factors in a Single Community-Based Hospital in Korea

Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

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