Population-Based Incidence of Carbapenem-Resistant <i>Klebsiella pneumoniae</i> along the Continuum of Care, Los Angeles County

Márquez, Patricia; Terashita, Dawn; Dassey, David E.; Mascola, Laurene

doi:10.1086/669087

Cited by 54 publications

(39 citation statements)

References 36 publications

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“…Overall, the pooled mean rate is lower than recently reported laboratory-based community-wide surveillance studies from other regions. 28 This is not surprising given a likely publication bias attributable to regions with "hyperendemic" CRE being more likely to publish rates. The fact that Michigan rates are lower than other published rates indicates an opportunity to prevent CRE from becoming hyperendemic in Michigan.…”

Section: Discussionmentioning

confidence: 99%

Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

Brennan

Coyle

Marchaim

et al. 2014

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

Brennan

Coyle

Marchaim

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…Other investigators have reported high incidence rates of CRE in postacute care settings, particularly long-term acute care hospitals. 9,10 Although the study by Guh et al may appear at odds with those other reports, the discrepancy might reflect differences in regional epidemiology that require distinct prevention strategies. Alternatively, the results may be explained by more temporally distant acquisition of CRE by patients; ie, carriage of CRE for more than 3 years after hospital discharge has been reported.…”

Section: 6mentioning

confidence: 83%

Measuring Carbapenem-Resistant Enterobacteriaceae in the United States

Hayden

2015

JAMA

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Carbapenem-resistant Enterobacteriaceae (CRE) may be the most concerning contemporary antibiotic resistance threat. Enterobacteriaceae comprise a large group of bacteria, including Escherichia coli and Klebsiella pneumoniae, and are common causes of health care-associated and community-acquired infections. Carbapenems, such as imipenem, meropenem, ertapenem, and doripenem are among the broadest-spectrum and most potent β-lactam antibiotics. For decades, carbapenems were reliably active against Enterobacteriaceae, and thus were frequently selected for empirical treatment of suspected serious gram-negative infections.Significant carbapenem resistance in Enterobacteriaceae was first described in 2001 in a US strain of K pneumoniae that produced an enzyme, termed "K pneumoniae carbapenemase" that was able to destroy all β-lactam antibiotics, including carbapenems.1 Infections due to K pneumoniae carbapenemase-producing CRE are overwhelming health careassociated infections, and mortality related to bloodstream infections is substantial, with an estimated case fatality rate of more than 50%. 1,2 This appears to be due more to delayed or inadequate antibiotic therapy for these multidrug-resistant organisms than to increased bacterial virulence. 2,3Reports of K pneumoniae carbapenemase increased rapidly after 2005, and several new carbapenemases were identified, most notably New Delhi metallo-β-lactamase and OXA-48-like oxacillinase.1 Carbapenemase-producing CRE have since spread globally, including into the community in developing countries, 1 although long-term reduction in incidence has been achieved in regions in which aggressive multimodal interventions were introduced early after CRE emergence. 4Carbapenem resistance can be due to mechanisms other than carbapenemase production; however, CRE that do not produce a carbapenemase are of lesser epidemiological importance because these organisms have not demonstrated the same potential for rapid transmission and regional spread. CI,] in 2013 in Maryland), with incidence rates in some regions high enough to suggest that CRE are endemic. The good news is that even in the region with the highest number of cases, the estimated crude incidence rate of CRE was relatively low (4.68 per 100 000 population in Georgia). The overall crude incidence rate of CRE in the network was estimated at 2.93 per 100 000. As noted by the authors, this rate is much lower than population-based estimates for established health careassociated pathogens, such as methicillin-resistant Staphylococcus aureus (25.1 per 100 000) or Clostridium difficile (147.2 per 100 000), and suggests that interventions implemented now to control CRE could have a sizeable effect. 4,6The study by Guh et al relied on data generated by local clinical laboratories, which resulted in some limitations. For instance, because knowledge of the mechanism of carbapenem resistance is not needed for treatment decisions, clinical laboratories usually do not characterize the mechanism of carbapenem resistance in CRE, thus, it was no...

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“…Consistent with the published literature indicating a higher prevalence of CRKP colonization and dissemination in patients in LTACs compared with those in acute care hospitals, we found that significantly more of the CRKP cohort resided in an SNF/LTAC, whereas the patients in the NRKP cohort were mostly admitted from home. [2][3][4][5][6][7][8]24 With respect to concurrent infections with other pathogens, patients in both groups were equally likely to have polymicrobial primary site infections, but those in the CRKP arm had significantly more concurrent infections at another site other than the primary site of infection. Importantly, patients in the CRKP arm had an up to 37-fold higher risk of having a coinfection with another carbapenem-resistant pathogen (eg, Pseudomonas); this difference was particularly evident in patients with pneumonia.…”

Section: Discussionmentioning

confidence: 99%