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Zamanian MH, Farhadian N, Sanaei S, Farhadian M. Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units: A Meta-Analysis. Microb Drug Resist 2025; 31:113-122. [PMID: 40160131 DOI: 10.1089/mdr.2024.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Introduction: Infections due to carbapenem-resistant Enterobacteriaceae (CRE) in intensive care units (ICUs) pose a significant threat. Colonization with CRE is a prerequisite for bacterial translocation/infections. This work aimed to determine risk factors for CRE colonization in ICU patients. Methods: To find relevant works, PubMed, EMBASE, and references of eligible studies were systematically searched using appropriate keywords up to September 2023. Odds ratios (ORs) and 95% confidence intervals were used to compare risk factor between CRE colonized cases and CRE noncolonized controls. Results: Twelve studies were included. Previous hospitalization (OR: 2.26), previous ICU stay (OR: 10.33), higher acute physiology and chronic health evaluation (APACHE) II score (mean difference [MD]: 4.38), central venous catheter (OR: 4.07), long-term gastric tube (OR: 3.01), hemodialysis catheter (OR: 3.38), urinary catheter (OR: 2.59), mechanical ventilation (OR: 3.41), endoscopy (OR: 3.37), tracheostomy (OR: 3.46), and exposure to antibiotics such as glycopeptide (OR: 10.68), aminoglycosides (OR: 6.53), tigecycline (OR: 6.87), vancomycin (OR: 5.32), carbapenems (OR: 5.23), cephalosporins (OR: 4.96), metronidazole (OR: 4.82), penicillin (OR: 4.41), and β-lactams/β-lactamase inhibitor (OR: 4.28) are highly associated with CRE colonization. Conclusions: ICU-admitted patients with prior hospitalization, ICU stay, previous antibiotic use, and invasive devices/procedures exposures should be prioritized in the screening strategy for CRE colonization to prevent nosocomial infections.
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Affiliation(s)
- Mohammad Hossein Zamanian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Farhadian
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahar Sanaei
- Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Pan S, Shi T, Ji J, Wang K, Jiang K, Yu Y, Li C. Developing and validating a machine learning model to predict multidrug-resistant Klebsiella pneumoniae-related septic shock. Front Immunol 2025; 15:1539465. [PMID: 39867898 PMCID: PMC11757138 DOI: 10.3389/fimmu.2024.1539465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 12/23/2024] [Indexed: 01/28/2025] Open
Abstract
Background Multidrug-resistant Klebsiella pneumoniae (MDR-KP) infections pose a significant global healthcare challenge, particularly due to the high mortality risk associated with septic shock. This study aimed to develop and validate a machine learning-based model to predict the risk of MDR-KP-associated septic shock, enabling early risk stratification and targeted interventions. Methods A retrospective analysis was conducted on 1,385 patients with MDR-KP infections admitted between January 2019 and June 2024. The cohort was randomly divided into a training set (n = 969) and a validation set (n = 416). Feature selection was performed using LASSO regression and the Boruta algorithm. Seven machine learning algorithms were evaluated, with logistic regression chosen for its optimal balance between performance and robustness against overfitting. Results The overall incidence of MDR-KP-associated septic shock was 16.32% (226/1,385). The predictive model identified seven key risk factors: procalcitonin (PCT), sepsis, acute kidney injury, intra-abdominal infection, use of vasoactive medications, ventilator weaning failure, and mechanical ventilation. The logistic regression model demonstrated excellent predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.906 in the training set and 0.865 in the validation set. Calibration was robust, with Hosmer-Lemeshow test results of P = 0.065 (training) and P = 0.069 (validation). Decision curve analysis indicated substantial clinical net benefit. Conclusion This study presents a validated, high-performing predictive model for MDR-KP-associated septic shock, offering a valuable tool for early clinical decision-making. Prospective, multi-center studies are recommended to further evaluate its clinical applicability and effectiveness in diverse settings.
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Affiliation(s)
- Shengnan Pan
- Department of Medical Laboratory, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Ting Shi
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Jinling Ji
- Department of Medical Laboratory, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Kai Wang
- Department of Rheumatology, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Kun Jiang
- Department of Medical Laboratory, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Yabin Yu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
| | - Chang Li
- Department of Medical Laboratory, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, China
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Langlois B, Guerin F, Isnard C, Gakuba C, Du Cheyron D, Giard JC, Brisse S, Le Hello S, Gravey F. Phenotypic and genomic changes in enteric Klebsiella populations during long-term ICU patient hospitalization: the role of RamR regulation. mSphere 2024; 9:e0070424. [PMID: 39611855 DOI: 10.1128/msphere.00704-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/01/2024] [Indexed: 11/30/2024] Open
Abstract
Acquired antimicrobial resistance and metabolic changes are central for bacterial host adaptation during the long-term hospitalization of patients. We aimed to analyze the genomic and phenotypic evolution of enteric Klebsiella populations in long-term intensive care unit (ICU) patients. Weekly rectal swabs were prospectively collected from all patients admitted to the ICU in a teaching hospital from December 2018 to February 2019. The inclusion criterion for patients was hospitalization for more than 15 days in the ICU without any history of hospitalization or antibiotic treatment for the 3 months prior to admission. Among them, enteric Klebsiella pneumoniae species complex (KpSC) populations were detected. For each isolate, extensive antimicrobial resistance profiles were determined using the disk diffusion method, and the whole genome was sequenced using an Illumina platform. In silico typing methods, such as Multilocus Sequence Typing (MLST), core-genome MLST, SNP typing, resistome characterization and mutation point detection, were applied. During the study period, 471 patients were admitted to ICUs. Among them, 21 patients met the inclusion criteria, and only 5 patients (24%) carried unique and distinct KpSC populations during 2-10 weeks in the gut that as detected at admission and excluding acquisition during the ICU stay. One patient showed a rare ST1563 K. variicola persistent carriage for 7 consecutive weeks, which displayed important antimicrobial resistance phenotype changes in the 2 last weeks. In-depth in silico characterization and RNA sequencing of these strains revealed a mutation within the ramR transcriptional regulator resulting in overexpression of the ramA regulator and decreased expression of acrR, which controls antibiotic efflux. This mutation also impacts tolerance to biliary salts. This study revealed the importance of endogenous colonization of KpSC populations in the gut throughout the patient's long-term ICU stay and highlighted the role of ramR in drug susceptibility. IMPORTANCE The Klebsiella pneumoniae species complex (KpSC) is one of the major causes of nosocomial infections, especially in intensive care unit (ICUs). These bacteria are frequently highly resistant to antibiotics, leading to an increase in morbidity and mortality. The origins of multidrug-resistant KpSC strains isolated from ICU patients are still unclear, with at least two hypotheses of acquisition paths: (i) endogenous KpSC populations that are or became resistant to antibiotics and/or (ii) hospital acquisition of circulating KpSC clones. Genomic changes observed in this study might reveal mechanisms to better adapt to KpSC in the patient's gut in the face of heavy ICU medical care pressure.
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Affiliation(s)
- Benedicte Langlois
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM, DYNAMICURE, Caen, France
| | - Francois Guerin
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM, DYNAMICURE, Caen, France
- Department of Infectious Agents, Bacteriology, CHU Caen, Caen, France
| | - Christophe Isnard
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM, DYNAMICURE, Caen, France
- Department of Infectious Agents, Bacteriology, CHU Caen, Caen, France
| | - Clement Gakuba
- Department of Surgical Intensive Care, CHU Caen, Caen, France
| | | | | | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Simon Le Hello
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM, DYNAMICURE, Caen, France
- Department of Infectious Agents, Bacteriology, CHU Caen, Caen, France
| | - Francois Gravey
- Univ de Caen Normandie, Univ Rouen Normandie, INSERM, DYNAMICURE, Caen, France
- Department of Infectious Agents, Bacteriology, CHU Caen, Caen, France
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Luo H, Chen X, Jiang Z, Yan Q. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents 2024; 63:107043. [PMID: 38040318 DOI: 10.1016/j.ijantimicag.2023.107043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Patients with haematological malignancies (HM patients) are at high risk of infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). MDR-GNB intestinal colonisation is associated with MDR-GNB infections. The aim of this systematic review and meta-analysis on HM patients was to pool the prevalence of and risk factors for intestinal colonisation by MDR-GNB, including carbapenem-resistant Enterobacterales (CRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, reported in previous studies. METHODS This study was conducted according to the protocol registered in PROSPERO (CRD42022374425). PubMed, Embase, Web of Science, Ovid MEDLINE(R) ALL and Cochrane Library were searched from inception to 25 October 2022. Observational studies reporting CRE and/or ESBL intestinal colonisation in HM patients were included. Subgroup analyses were conducted by study region. RESULTS A total of 21 402 HM patients from 32 studies were analysed. The pooled CRE and ESBL colonisation rates were 21.7% [95% confidence interval (95%CI) 18.7-24.8] and 19.2% (95%CI 13.9-24.5), respectively. Prior exposure to tigecycline [odds ratio (OR) 3.99, 95%CI 2.08-7.68], carbapenem (OR 1.84, 95%CI 1.13-2.97) or penicillin (OR 1.72, 95%CI 1.05-2.83), as well as chemotherapy (OR 2.45, 95%CI 1.05-5.73), neutropenia (OR 1.88, 95%CI 1.08-3.26) and acute myeloid leukaemia (AML; OR 1.86, 95%CI 1.33-2.61), were risk factors for CRE colonisation in HM patients. Prior antibiotic exposure was a risk factor for ESBL colonisation in HM patients (OR 4.90, 95%CI 2.76-8.70). CONCLUSIONS This study shows the high prevalence of MDR-GNB (CRE and ESBL) colonisation in HM patients and explains associated factors for the colonisation. The results provide evidence for MDR-GNB infection control in HM management.
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Affiliation(s)
- Huijuan Luo
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xia Chen
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiping Jiang
- Department of Haematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China..
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Dai Y, Zhang L, Pan T, Shen Z, Meng T, Wu J, Gu F, Wang X, Tan R, Qu H. The ICU-CARB score: a novel clinical scoring system to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission. Antimicrob Resist Infect Control 2023; 12:118. [PMID: 37898771 PMCID: PMC10613373 DOI: 10.1186/s13756-023-01326-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With the widespread spread of carbapenem-resistant gram-negative bacteria (CR-GNB) in medical facilities, the carriage of CR-GNB among critically ill patients has become a significant concern in intensive care units (ICU). This study aimed to develop a scoring system to identify CR-GNB carriers upon ICU admission. METHODS Consecutive critically ill patients admitted to the ICU of Shanghai Ruijin Hospital between January 2017 and December 2020 were included. The patients were then divided into training and testing datasets at a 7:3 ratio. Parameters associated with CR-GNB carriage were identified using least absolute shrinkage and selection operator regression analysis. Each parameter was assigned a numerical score ranging from 0 to 100 using logistic regression analysis. Subsequently, a four-tier risk-level system was developed based on the cumulative scores, and assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of the 1736 patients included in this study, the prevalence of CR-GNB carriage was 10.60%. The clinical scoring system including seven variables (neurological disease, high-risk department history, length of stay ≥ 14 days, ICU history, invasive mechanical ventilation, gastrointestinal tube placement, and carbapenem usage) exhibited promising predictive capabilities. Patients were then stratified using the scoring system, resulting in CR-GNB carriage rates of 2.4%, 12.0%, 36.1%, and 57.9% at the respective risk levels (P < 0.001). Furthermore, the AUC of the developed model in the training set was calculated to be 0.82 (95% CI, 0.78-0.86), while internal validation yielded an AUC of 0.83 (95% CI, 0.77-0.89). CONCLUSIONS The ICU-CARB Score serves as a straightforward and precise tool that enables prompt evaluation of the risk of CR-GNB carriage at the time of ICU admission, thereby facilitating the timely implementation of targeted pre-emptive isolation.
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Affiliation(s)
- Yunqi Dai
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianjiao Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Yoo EH, Hong HL, Kim EJ. Epidemiology and Mortality Analysis Related to Carbapenem-Resistant Enterobacterales in Patients After Admission to Intensive Care Units: An Observational Study. Infect Drug Resist 2023; 16:189-200. [PMID: 36644658 PMCID: PMC9833324 DOI: 10.2147/idr.s391409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The prevalence of carbapenem-resistant Enterobacterales (CRE) is rapidly increasing worldwide. Patients in the intensive care unit (ICU) are susceptible to CRE infections, and the related mortality rate is increased. It is necessary to understand CRE strains and risk factors for CRE infection in the ICU, to facilitate development of effective prophylactic strategies and treatments for ICU patients. Patients and Methods This observational study was conducted in a tertiary hospital between 2016 and 2021. The subjects were patients with CRE cultured from specimens obtained after ICU admission. Genotypes of strains of CRE and carbapenemase-producing Enterobacterales (CPE) were identified, CRE infection was distinguished from mere colonization, and the clinical course of these patients was investigated. Results Among 327 CRE cases, 84 (25.7%) showed infection and 243 (74.3%) showed colonization. Of these patients, 138 (42.2%) died. The CRE strains were Klebsiella pneumoniae (253 cases, 77.4%), Enterobacter cloacae (44 cases, 13.5%), and Escherichia coli (15 cases, 4.6%). Among CRE cases, CPE was found in 249 (76.1%), including Klebsiella pneumoniae carbapenemase (KPC) in 164 (65.9%), and Guiana extended-spectrum (GES) in 64 (25.7%). A bedridden state, longer ICU stay, chronic kidney disease, malignancy, connective tissue disease, ICU admission for cardiac arrest, and CRE infection were associated with higher mortality, but cerebrovascular disease and ICU admission for trauma were associated with lower mortality. GES outbreak was caused by person-to-person transmission and was controlled through active surveillance. Conclusion The frequency of K. pneumoniae and KPC was the highest, but E. cloacae and GES was characteristically high in this study. Active CRE surveillance can be helpful for controlling outbreak.
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Affiliation(s)
- Eun Hyung Yoo
- Department of Laboratory Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea,Correspondence: Eun Jin Kim, Department of Internal Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17gil, Namgu, Daegu, 42472, Korea, Tel +82-53-650-4274, Fax +82-53-650-4942, Email
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Kuruvilla T, Raju K, Joseph S. Screening for carriers of carbapenemase producing Enterobacteriaceae in critical care units. SAUDI JOURNAL FOR HEALTH SCIENCES 2023. [DOI: 10.4103/sjhs.sjhs_143_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Oh J, Park SY, Lee JS, Lee SH. Effect of restricting piperacillin/tazobactam prescription on rates of antimicrobial resistance in gram-negative bacteria and antibiotic consumption. Eur J Clin Microbiol Infect Dis 2023; 42:53-60. [PMID: 36378363 DOI: 10.1007/s10096-022-04525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
The increasing resistance of gram-negative bacteria is a serious global public health concern. One way to prevent increasing antibiotic resistance is by implementing the antibiotic stewardship program. This study aimed to assess the changes in the consumption of antimicrobials and antimicrobial resistance rates after implementing piperacillin/tazobactam restriction. This study was conducted at Kandong Sacred Heart Hospital. We retrospectively collected and analysed data between October 2018 and May 2021 to evaluate antibiotic consumption and resistance patterns after restricting piperacillin/tazobactam. This study included two periods, a 16-month pre-restriction period and a 16-month post-restriction period. During the study period, there was a significant decrease in the consumption of piperacillin/tazobactam after implementing the restriction policy (127.82 ± 9.39 to 104.82 ± 15.66 defined daily doses/1000 patient days, p < 0.001). A significant decrease in the resistance rate of Acinetobacter spp. was observed for cefepime (p = 0.001), ceftazidime (p = 0.004), levofloxacin (p = 0.021), meropenem (p = 0.002) and piperacillin (p = 0.028). The introduction of piperacillin/tazobactam restriction reduced their use and positively impacted the resistance rates of Acinetobacter spp., carbapenem-resistant Pseudomonas spp. and carbapenem-resistant Enterobacteriaceae which are major threats to nosocomial infections.
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Affiliation(s)
- Jihyu Oh
- Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150, Seongan-Ro, Gangdong-Gu, Seoul, 05355, Republic of Korea
| | - So Yeon Park
- Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150, Seongan-Ro, Gangdong-Gu, Seoul, 05355, Republic of Korea.
| | - Jin Seo Lee
- Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150, Seongan-Ro, Gangdong-Gu, Seoul, 05355, Republic of Korea
| | - Seo Hu Lee
- Division of Infectious Disease, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150, Seongan-Ro, Gangdong-Gu, Seoul, 05355, Republic of Korea
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Papafotiou C, Roussos S, Sypsa V, Bampali S, Spyridopoulou K, Karapanou A, Moussouli A, Samarkos M, Daikos GL, Psichogiou M. Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area. J Antimicrob Chemother 2022; 77:3331-3339. [PMID: 36203392 DOI: 10.1093/jac/dkac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. METHODS The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. RESULTS Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. CONCLUSIONS This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures.
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Affiliation(s)
- Chrysanthe Papafotiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Bampali
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kalliopi Spyridopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasia Moussouli
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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Wangchinda W, Thamlikitkul V, Watcharasuwanseree S, Tangkoskul T. Active Surveillance for Carbapenem-Resistant Enterobacterales (CRE) Colonization and Clinical Course of CRE Colonization among Hospitalized Patients at a University Hospital in Thailand. Antibiotics (Basel) 2022; 11:antibiotics11101401. [PMID: 36290059 PMCID: PMC9598097 DOI: 10.3390/antibiotics11101401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Optimal measures for preventing and controlling carbapenem-resistant Enterobacterales (CRE) depend on their burden. This prospective observational study investigated the prevalence and clinical course of CRE colonization in hospitalized patients at Siriraj Hospital, the largest university hospital in Thailand. Stool/rectal swab samples were collected from the patients upon admission, once weekly during hospitalization and every 1–3 months after discharge, to determine the presence of CRE in the stool. Between 2018 and 2021, a total of 528 patients were included. The prevalence of CRE colonization upon admission was 15.5%, while 28.3% of patients who tested negative for CRE on admission acquired CRE during their hospitalization. CRE colonization upon admission was usually associated with prior healthcare exposure. Among CRE-colonized patients, 4.7% developed a CRE clinical infection, with 60% mortality. No cutoff period that ensured that patients were free of CRE colonization in stool was identified, and isolation precautions should only be ceased if stool tests are negative for CRE. In conclusion, the prevalence of CRE colonization among hospitalized patients at Siriraj Hospital is high. CRE-colonized patients are at risk of developing subsequent CRE infection. To prevent CRE transmission within the hospital, patients at high risk of colonization should undergo CRE screening upon admission.
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Wangchinda W, Laohasakprasit K, Lerdlamyong K, Thamlikitkul V. Epidemiology of Carbapenem-Resistant Enterobacterales Infection and Colonization in Hospitalized Patients at a University Hospital in Thailand. Infect Drug Resist 2022; 15:2199-2210. [PMID: 36312438 PMCID: PMC9612804 DOI: 10.2147/idr.s361013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the epidemiology of carbapenem-resistant Enterobacterales (CRE) colonization or CRE infection relative to the natural history and clinical course of CRE colonization or CRE infection in hospitalized patients during admission and after discharge. Material and Methods Two adult cohorts were enrolled. Cohort I comprised hospitalized patients who had CRE isolated from their clinical specimens during 2018–2020. CRE colonization or CRE infection was based on the absence/presence of clinical features of infection. Information regarding the natural history and clinical course of these patients was collected during hospitalization. Stool samples were evaluated for CRE once a week during hospitalization, and then once every few months after discharge until negative for CRE. Cohort II comprised patients who had CRE isolated from clinical specimens during hospitalization and who were discharged during 2015–2018. CRE in stool samples collected from these patients every few months was assessed to determine duration of CRE in stool. Results CRE in stool was detected in 69.7% of 353 patients in cohort I. K. pneumoniae was the predominant CRE isolated from clinical samples (76.8%) and stool samples (65.7%). Among the 225 CRE-colonized patients, 20.4% developed subsequent CRE infections with a median duration from CRE colonization to CRE infection of 14 days. Among 174 CRE-infected patients, the most common infection was pneumonia with mortality at discharge of 47.7%. Duration of CRE colonization in stool was <1 year in 50.0% of cohort I patients, and <2 years in 91.4% of patients in cohort II. Conclusion CRE isolated from clinical specimens in hospitalized patients are more likely to cause colonization than infection. Patients with CRE colonization are at risk of subsequent CRE infection with high mortality. Stool culture for CRE is needed to verify if contact precautions can be discontinued because the duration of CRE colonization in stool varied from days to years.
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Affiliation(s)
- Walaiporn Wangchinda
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwan Laohasakprasit
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokorn Lerdlamyong
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Visanu Thamlikitkul, Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand, Tel +66 81-820-6271, Fax +66 2-412-5994, Email
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Del Rio A, Muresu N, Sotgiu G, Saderi L, Sechi I, Cossu A, Usai M, Palmieri A, Are BM, Deiana G, Cocuzza C, Martinelli M, Calaresu E, Piana AF. High-Risk Clone of Klebsiella pneumoniae Co-Harbouring Class A and D Carbapenemases in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052623. [PMID: 35270321 PMCID: PMC8909938 DOI: 10.3390/ijerph19052623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is endemic globally, causing severe infections in hospitalized patients. Surveillance programs help monitor and promptly identify the emergence of new clones. We reported the rapid spread of a novel clone of K. pneumoniae co-harbouring class A and D carbapenemases in colonized patients, and the potential risk factors involved in the development of infections. Methods: Rectal swabs were used for microbiological analyses and detection of the most common carbapenemase encoding genes by real-time PCR (i.e., blaKPC, blaOXA-48, blaNDM, blaVIM, and blaIMP). All strains co-harbouring KPC and OXA-48 genes were evaluated. For each patient, the following variables were collected: age, sex, length and ward of stay, device use, and outcome. Clonality of CR-Kp was assessed by preliminary pulsed field gel electrophoresis (PFGE), followed by multi-locus sequence typing (MLST) analyses. Results: A total of 127 isolates of K. pneumoniae co-harbouring KPC and OXA-48 were collected between September 2019 and December 2020. The median age (IQR) of patients was 70 (61–77). More than 40% of patients were admitted to intensive care unit (ICU). Around 25% of patients developed an invasive infection, the majority of which were respiratory tract infections (17/31; 54.8%). ICU stay and invasive infection increased the risk of mortality (OR: 5.39, 95% CI: 2.42–12.00; OR 6.12, 95% CI: 2.55–14.69, respectively; p-value ≤ 0.001). The antibiotic susceptibility test showed a resistance profile for almost all antibiotics considered. Monoclonal origin was confirmed by PFGE and MLST showing a similar restriction pattern and belonging to ST-512. Conclusions: We report the spread and the marked antibiotic resistance profiles of K. pneumoniae strains co-producing KPC and OXA-48. Further study could clarify the roles of clinical and microbiological variables in the development of invasive infection and increasing risk of mortality, in colonized patients.
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Affiliation(s)
- Arcadia Del Rio
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy; (A.D.R.); (G.D.)
| | - Narcisa Muresu
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
- Correspondence: ; Tel.: +39-079-229959
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Illari Sechi
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
| | - Andrea Cossu
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
| | - Manuela Usai
- Department of Humanistic and Social Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Alessandra Palmieri
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
| | - Bianca Maria Are
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
| | - Giovanna Deiana
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, 07100 Sassari, Italy; (A.D.R.); (G.D.)
| | - Clementina Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.C.); (M.M.); (E.C.)
| | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.C.); (M.M.); (E.C.)
| | - Enrico Calaresu
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (C.C.); (M.M.); (E.C.)
| | - Andrea Fausto Piana
- Hygiene Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (N.M.); (I.S.); (A.C.); (A.P.); (B.M.A.); (A.F.P.)
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13
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Arzilli G, Scardina G, Casigliani V, Petri D, Porretta A, Moi M, Lucenteforte E, Rello J, Lopalco P, Baggiani A, Privitera GP, Tavoschi L. Screening for Antimicrobial-Resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review. J Infect 2021; 84:119-130. [PMID: 34793762 DOI: 10.1016/j.jinf.2021.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) among hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation. METHODS We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries. RESULTS The search retrieved 11853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection among colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3). CONCLUSIONS While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy.
| | - Marco Moi
- Department of Surgical Sciences, University of Cagliari, Cagliari 09124, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Jordi Rello
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Clinical Research, CHU Nîmes, Nîmes, France
| | - Pierluigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Gaetano Pierpaolo Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
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14
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Yi J, Kim KH. Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units. Acute Crit Care 2021; 36:175-184. [PMID: 34380190 PMCID: PMC8435449 DOI: 10.4266/acc.2021.00409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.
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Affiliation(s)
- Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kye-Hyung Kim
- Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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15
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Nakamura A, Shinke T, Noguchi N, Komatsu M, Yamanishi H. Evaluation of the detection ability of uropathogen morphology and vaginal contamination by the Atellica UAS800 automated urine microscopy analyzer and its effectiveness. J Clin Lab Anal 2021; 35:e23698. [PMID: 33426721 PMCID: PMC7957992 DOI: 10.1002/jcla.23698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 11/09/2022] Open
Abstract
Background To help combat the worldwide spread of multidrug‐resistant Enterobacterales, which are responsible for many causes of urinary tract infection (UTI), we evaluated the ability of the Atellica UAS800 automated microscopy system, the only one offering the capability of bacterial morphological differentiation, to determine its effectiveness. Methods We examined 118 outpatient spot urine samples in which pyuria and bacteriuria were observed using flow cytometry (training set: 81; cross‐validation set: 37). The ability of the Atellica UAS800 to differentiate between bacilli and cocci was verified. To improve its ability, multiple logistic regression analysis was used to construct a prediction formula. Results This instrument's detection sensitivity was 106 CFU/ml, and reproducibility in that range was good, but data reliability for the number of cocci was low. Multiple logistic regression analysis with each explanatory variable (14 items from the Atellica UAS800, age and sex) showed the best prediction formula for discrimination of uropathogen morphology was a model with 5 explanatory variables: number of bacilli (p < 0.001), squamous epithelial cells (p = 0.004), age (p = 0.039), number of cocci (p = 0.107), and erythrocytes (p = 0.111). For a predicted cutoff value of 0.449, sensitivity was 0.879 and specificity was 0.854. In the cross‐validation set, sensitivity was 0.813 and specificity was 0.857. Conclusions The Atellica UAS800 could detect squamous epithelial cells, an indicator of vaginal contamination, with high sensitivity, which further improved performance. Simultaneous use of this probability prediction formula with urinalysis results may facilitate real‐time prediction of uropathogens and vaginal contamination, thus providing helpful information for empiric therapy.
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Affiliation(s)
- Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Tetsuya Shinke
- Department of Clinical Bacteriology, Clinical Laboratory Medicine, Tenri Hospital, Tenri, Japan
| | - Nobuyoshi Noguchi
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan.,Department of Clinical Bacteriology, Clinical Laboratory Medicine, Tenri Hospital, Tenri, Japan
| | - Masaru Komatsu
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Hachiro Yamanishi
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
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16
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Corcione S, Lupia T, Maraolo AE, Mornese Pinna S, Gentile I, De Rosa FG. Carbapenem-sparing strategy: carbapenemase, treatment, and stewardship. Curr Opin Infect Dis 2020; 32:663-673. [PMID: 31599774 DOI: 10.1097/qco.0000000000000598] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW describing the current role of carbapenems and carbapenem-sparing strategies in the setting of antimicrobial stewardship programs. RECENT FINDINGS sparing carbapenems with other drugs appears to be an interesting perspective for a variety of reasons in the current context of the multidrug-resistant (MDR) pandemic. Specific algorithms should also be precisely investigated to define better how to spare carbapenems within empiric and targeted regimens, with combination treatment or monotherapies, aiming at the best use of the new drugs and improving de-escalation as soon as possible for most of the patients. SUMMARY stewardship programs may be useful in reducing probable misuse and overuse of antibiotics, which has probably contributed to the emergence of carbapenem-resistant bacteria worldwide. The proposal of carbapenem-sparing strategies has then generated substantial scientific debate and, overall, the concept of sparing these drugs is well advocated together with judicious use of novel drugs, appropriate measures of infection control and prevention as well as in stewardship programs to curb the spread of MDR and XDR-strains in healthcare facilities.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples Federico II, Naples, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples Federico II, Naples, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
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Choy A, Freedberg DE. Impact of microbiome-based interventions on gastrointestinal pathogen colonization in the intensive care unit. Therap Adv Gastroenterol 2020; 13:1756284820939447. [PMID: 32733601 PMCID: PMC7370550 DOI: 10.1177/1756284820939447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/15/2020] [Indexed: 02/04/2023] Open
Abstract
In the intensive care unit (ICU), colonization of the gastrointestinal tract by potentially pathogenic bacteria is common and often precedes clinical infection. Though effective in the short term, traditional antibiotic-based decolonization methods may contribute to rising resistance in the long term. Novel therapies instead focus on restoring gut microbiome equilibrium to achieve pathogen colonization resistance. This review summarizes the existing data regarding microbiome-based approaches to gastrointestinal pathogen colonization in ICU patients with a focus on prebiotics, probiotics, and synbiotics.
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Affiliation(s)
| | - Daniel E. Freedberg
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
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18
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Salomão MC, Freire MP, Boszczowski I, Raymundo SF, Guedes AR, Levin AS. Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Emerg Infect Dis 2020; 26:1156-1163. [PMID: 32267827 PMCID: PMC7258474 DOI: 10.3201/eid2606.190965] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) colonization is common in hospital patients admitted to intensive care units (ICU) from the emergency department. We evaluated the effect of previous hospitalization in the emergency department on CRE colonization at ICU admission. Our case–control study included 103 cases and 201 controls; cases were patients colonized by CRE at admission to ICU and controls were patients admitted to ICU and not colonized. Risk factors were emergency department stay, use of carbapenem, Simplified Acute Physiology Score, upper digestive endoscopy, and transfer from another hospital. We found that ED stay before ICU admission was associated with CRE colonization at admission to the ICU. Our findings indicate that addressing infection control problems in EDs will help to control carbapenem resistance in ICUs.
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19
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Kumudunie WGM, Wijesooriya LI, Namalie KD, Sunil-Chandra NP, Wijayasinghe YS. Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla KPC harboring Klebsiella pneumoniae. J Infect Public Health 2020; 13:1330-1335. [PMID: 32439355 DOI: 10.1016/j.jiph.2020.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) and carbapenem-resistant Enterobacteriaceae (CRE) are disseminated worldwide posing a serious public health concern. Although, the presence of ESBL-PE and CRE in Sri Lanka has been reported, the prevalence is unknown. This study aimed to provide up-to-date epidemiological data on multidrug-resistant Enterobacteriaceae and to characterize the molecular determinants of carbapenemase-producing Enterobacteriaceae (CPE) in Sri Lanka. METHODS A prospective cross-sectional study was conducted at a tertiary care hospital in Sri Lanka between December 2017 and February 2018. ESBL-PE and CRE were identified by disc diffusion method. Carbapenemase production was determined by carbapenem inactivation method and the presence of selected carbapenemase genes were detected by PCR. RESULTS Five hundred and ninety three Enterobacteriaceae were isolated from variety of clinical samples. Overall prevalence of ESBL-PE and CRE were 26.0% (n = 154) and 9.6% (n = 57), respectively. The highest rate of ESBL-PE (30.8%) was found in urine samples, while the highest occurrence of CRE (20.8%) was seen in respiratory specimens. The most common CRE species identified was K. pneumoniae (n = 46, 80.7%), followed by C. freundii (n = 4, 7.0%), E. coli (n = 3, 5.3%), P. rettgeri (n = 2, 3.5%), E. cloacae (n = 1, 1.7%), and K. aerogenes (n = 1, 1.7%). Carbapenemase production was observed in 54 (94.7%) of CRE isolates. Fifty eight carbapenemase encoding genes were identified in 54 CPE. The most prevalent carbapenemase gene was blaOXA-48-like (n = 48, 88.9%), followed by blaNDM (n = 8, 14.8%), and blaKPC (n = 2, 3.7%). CONCLUSION This study reports an alarming rate of CRE and the emergence of blaKPC harboring K. pneumoniae in Sri Lanka. The need for preventive measures is highlighted to limit the spread of these difficult-to-treat bacteria in the country.
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Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species. J Hosp Infect 2020; 104:456-468. [PMID: 31931046 PMCID: PMC7193892 DOI: 10.1016/j.jhin.2020.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022]
Abstract
Introduction Risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition/infection and associated clinical outcomes have been evaluated in the context of clonal, species-specific outbreaks. Equivalent analyses for complex, multi-species outbreaks, which are increasingly common, are lacking. Methods Between December 2010 and January 2017, a case–control study of Klebsiella pneumoniae carbapenemase (KPC)-producing organism (KPCO) acquisition was undertaken using electronic health records from inpatients in a US academic medical centre and long-term acute care hospital (LTACH) with ongoing multi-species KPCO transmission despite a robust CPE screening programme. Cases had a first KPCO-positive culture >48 h after admission, and included colonizations and infections (defined by clinical records). Controls had at least two negative perirectal screens and no positive cultures. Risk factors for KPCO acquisition, first infection following acquisition, and 14-day mortality following each episode of infection were identified using multi-variable logistic regression. Results In 303 cases (89 with at least one infection) and 5929 controls, risk factors for KPCO acquisition included: longer inpatient stay, transfusion, complex thoracic pathology, mechanical ventilation, dialysis, and exposure to carbapenems and β-lactam/β-lactamase inhibitors. Exposure to other KPCO-colonized patients was only a risk factor for acquisition in a single unit, suggesting that direct patient-to-patient transmission did not play a major role. There were 15 species of KPCO; 61 (20%) cases were colonized/infected with more than one species. Fourteen-day mortality following non-urinary KPCO infection was 20% (20/97 episodes) and was associated with failure to achieve source control. Conclusions Healthcare exposures, antimicrobials and invasive procedures increased the risk of KPCO colonization/infection, suggesting potential targets for infection control interventions in multi-species outbreaks. Evidence for patient-to-patient transmission was limited.
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Grasselli G, Scaravilli V, Alagna L, Bombino M, De Falco S, Bandera A, Abbruzzese C, Patroniti N, Gori A, Pesenti A. Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome. Ann Intensive Care 2019; 9:141. [PMID: 31853672 PMCID: PMC6920277 DOI: 10.1186/s13613-019-0615-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/05/2019] [Indexed: 01/12/2023] Open
Abstract
Background In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed. Results Ninety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11). Conclusions In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.
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Affiliation(s)
- Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.
| | - Vittorio Scaravilli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy
| | - Laura Alagna
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Michela Bombino
- Department of Anesthesia, Critical Care and Emergency, ASST Monza San Gerardo Hospital, Monza, MB, Italy
| | - Stefano De Falco
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.,Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Chiara Abbruzzese
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy
| | - Nicolò Patroniti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.,Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy
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22
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Lin MY, Ray MJ, Rezny S, Runningdeer E, Weinstein RA, Trick WE. Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database. Open Forum Infect Dis 2019; 6:ofz483. [PMID: 32128328 PMCID: PMC7047960 DOI: 10.1093/ofid/ofz483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/07/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Timely identification of patients likely to harbor carbapenem-resistant Enterobacteriaceae (CRE) can help health care facilities provide effective infection control and treatment. We evaluated whether a model utilizing prior health care information from a state hospital discharge database could predict a patient's probability of CRE colonization at the time of hospital admission. METHODS We performed a case-control study using the Illinois hospital discharge database. From a 2014-2015 patient cohort, we defined cases as index adult patient hospital encounters with a positive CRE culture collected within the first 3 days of hospitalization, as reported to the Illinois XDRO registry; controls were all patient admissions from the same hospital and month. We split the data into training (~60%) and validation (~40%) sets and developed a logistic regression model to estimate coefficients for predictors of interest. RESULTS We identified 486 index cases and 340 005 controls. Independent risk factors for CRE at the time of admission were age, number of short-term acute care hospital (STACH) hospitalizations in the prior 365 days, mean STACH length of stay, number of long-term acute care hospital (LTACH) hospitalizations in the prior 365 days, mean LTACH length of stay, current admission to LTACH, and prior hospital admission with an infection diagnosis code. When applying the model to the validation data set, the area under the receiver operating characteristic curve was 0.84. CONCLUSIONS A prediction model utilizing prior health care exposure information could discriminate patients who were likely to harbor CRE at the time of hospital admission.
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Affiliation(s)
- Michael Y Lin
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael J Ray
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Serena Rezny
- Illinois Department of Public Health, Chicago, Illinois, USA
| | | | - Robert A Weinstein
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - William E Trick
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
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23
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Del Puente F, Giacobbe DR, Salsano A, Maraolo AE, Ong DSY, Yusuf E, Tutino S, Marchese A, Santini F, Viscoli C. Epidemiology and outcome of Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) infections in cardiac surgery patients: a brief narrative review. J Chemother 2019; 31:359-366. [PMID: 31701842 DOI: 10.1080/1120009x.2019.1685794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) is a difficult-to-treat pathogen due to its multidrug-resistant phenotype. Cardiac surgery patients are at increased risk of developing KPC-KP infections compared to other populations, with previous KPC-KP colonization being a critical factor in influencing the risk of subsequent infection. Two different pieces of information are essential to comprehensively assess the local characteristics of KPC-KP colonization in cardiac surgery patients: (i) the local prevalence of colonization; (ii) the timing of colonization. Treatment of KPC-KP infections in cardiac surgery patients is a complex task, but more effective treatment options have recently become available. Nonetheless, implementation and full adherence to infection-control measures remain of pivotal importance for reducing the burden of KPC-KP infections in this peculiar population. The aim of this narrative review is to summarize the available literature on the epidemiology and outcome of KPC-KP infections in cardiac surgery patients.
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Affiliation(s)
- Filippo Del Puente
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Salsano
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Alberto E Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Erlangga Yusuf
- Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefania Tutino
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Anna Marchese
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Microbiology Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesco Santini
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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24
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Ramanathan YV, Venkatasubramanian R, Nambi PS, Ramabathiran M, Venkataraman R, Thirunarayan MA, Samundeeswari P, Ramakrishnan N. Carbapenem-resistant enterobacteriaceae screening: A core infection control measure for critical care unit in India? Indian J Med Microbiol 2019; 36:572-576. [PMID: 30880709 DOI: 10.4103/ijmm.ijmm_18_437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Infection/colonization due to carbapenem-resistant enterobacteriaceae (CRE) are emerging as an important challenge, particularly in high risk patients due to widespread use of Carbapenems. Therefore, preventing both CRE infections and their transmission has become an important infection control objective. Aims and Objective Determine the proportion of asymptomatic carriers of CRE among patients admitted to our critical care unit (CCU) from the community and other health care facilities. Enumerate risk factors and guide implementation of infection control interventions. Methods This prospective surveillance study was done in a 24 bed CCU of a tertiary care hospital, at Chennai, India between August2017 through December 2017. Patients were screened based on a composed questionnaire framed from Centers for Diseases Control and Prevention CRE tool-kit. Two rectal swabs were collected from each patient. They were processed in microbiology laboratory. Results A total of 102 patients were included. CRE colonization were identified in 8 (7.8%) of the total samples. Among 8 CRE colonized patients 3 (37.5%) patients developed systemic infection. Patients who were exposed to high end antibiotic and past history of surgery had significant association with CRE colonization of (P = 0.0029) and (P = 0.0167) respectively. Conclusion Overall CRE colonization rates among our CCU patients were found to be low. Risk factors associated with CRE colonization were high end antibiotic exposure and surgery in past 90 days. Hence rectal screening should be a risk factor-based active surveillance. Association of systemic infection among CRE colonizers was more significant. This study led us to modify our infection control practices in CCU.
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Affiliation(s)
| | | | - P Senthur Nambi
- Institute of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
| | | | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - M A Thirunarayan
- Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - P Samundeeswari
- Institute of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
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25
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Kang JS, Yi J, Ko MK, Lee SO, Lee JE, Kim KH. Prevalence and Risk Factors of Carbapenem-resistant Enterobacteriaceae Acquisition in an Emergency Intensive Care Unit in a Tertiary Hospital in Korea: a Case-Control Study. J Korean Med Sci 2019; 34:e140. [PMID: 31074254 PMCID: PMC6509365 DOI: 10.3346/jkms.2019.34.e140] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are associated with high mortality rates and their treatment is difficult because treatment is limited to certain antibiotics, such as colistin and tigecycline. We aimed to perform active surveillance culture of CRE (ASC-CRE) to monitor the prevalence of CRE acquisition during intensive care unit (ICU) care and to examine the potential risk factors associated with CRE acquisition. METHODS We conducted ASC-CRE on patients who were admitted to the ICU in the emergency room at a tertiary hospital. Rectal swabs were analyzed using methods established by the Centers for Disease Control and Prevention. To detect carbapenemase-producing CRE, a polymerase chain reaction assay to detect five carbapenemase genes (blaNDM, blaKPC, blaVIM, blaIMP-1, and blaOXA-48) was performed. RESULTS There were 22 CRE acquisition in 21 patients (2.6%, 21/810) and the incidence of CRE acquisition was 4.3/1,000 person-days, respectively. The most common species detected was Klebsiella pneumoniae (72.7%, 16/22), and 9 carbapenemase-producing CREs (7 blaKPC and 2 blaNDM) were detected. Independent risk factors associated with CRE acquisition were men gender (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 1.3-21.3), history of admission within one year (aOR, 3.9; 95% CI, 1.2-12.1), co-colonization with multidrug-resistant Acinetobacter baumannii (aOR, 15.6; 95% CI, 3.6-67.8) and extended-spectrum β-lactamases-producing bacteria (aOR, 4.7; 95% CI, 1.5-14.6), and exposure to glycopeptide antibiotics (aOR, 3.6; 95% CI, 1.3-9.9). CONCLUSION The identification of patients with risk factors for CRE acquisition and early detection of CRE acquisition using ASC-CRE may be useful for CRE control.
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Affiliation(s)
- Jin Suk Kang
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Mee Kyung Ko
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soon Ok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Eun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Kye Hyung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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26
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Meng X, Yang J, Duan J, Liu S, Huang X, Wen X, Huang X, Fu C, Li J, Dou Q, Liu Y, Wang J, Yan Q, Zou M, Liu W, Peng Z, Chen L, Li C, Wu A. Assessing Molecular Epidemiology of Carbapenem-resistant Klebsiella pneumoniae (CR-KP) with MLST and MALDI-TOF in Central China. Sci Rep 2019; 9:2271. [PMID: 30783127 PMCID: PMC6381170 DOI: 10.1038/s41598-018-38295-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/12/2018] [Indexed: 01/25/2023] Open
Abstract
Carbapenem-resistant K. pneumoniae (CR-KP) posts significant public health challenge worldwide. The aim of this study is to assess clinical characteristics and molecular epidemiology of CR-KP infections with Multilocus sequence typing (MLST) and Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) in Central China. A total of 71 CR-KP isolates were recovered in a teaching hospital from October 2014 to December 2015. Among all CR-KP isolates, 73.2% (52) produced K. pneumoniae carbapenemases-2 (KPC-2). Eighteen ST types were identified by MLST, among these ST types, forty-seven isolates belonged to ST11 type, which was the predominant outbreak strain in China, and most ST11 isolates produced KPC-2. Eleven mass spectrometry (MS) types were identified by MALDI-TOF MS analysis, 53.5% isolates were MS4 and MS6, which matched with ST11 in MLST analysis. CR-KP infection was associated with increased medical cost and longer hospitalization. Therefore, we found that KPC-2-producing ST11 (MS4 and MS6) CR-KP isolates were the predominant clone identified by MLST and MALDI-TOF, and CR-KP infection was associated with increased hospital costs and longer hospitalization.
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Affiliation(s)
- Xiujuan Meng
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jun Yang
- Bioyong Technologies Inc, Beijing, China
| | - Juping Duan
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Sidi Liu
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xun Huang
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ximao Wen
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xin Huang
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Chenchao Fu
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jie Li
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qingya Dou
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yao Liu
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jia Wang
- Bioyong Technologies Inc, Beijing, China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Mingxiang Zou
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Wenen Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zhong Peng
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Liang Chen
- Public Health Research Institute Tuberculosis Center, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Chunhui Li
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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27
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Sun QL, Gu D, Wang Q, Hu Y, Shu L, Hu J, Zhang R, Chen GX. Dynamic Colonization of Klebsiella pneumoniae Isolates in Gastrointestinal Tract of Intensive Care Patients. Front Microbiol 2019; 10:230. [PMID: 30804922 PMCID: PMC6378299 DOI: 10.3389/fmicb.2019.00230] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/28/2019] [Indexed: 01/01/2023] Open
Abstract
Gastrointestinal carriage is regarded as a major reservoir of K. pneumoniae infections, especially in intensive care patients. A total of 101 (95.3%) KPC-producing carbapenem-resistant K. pneumoniae (CRKP) isolates were identified among 106 CRKP isolates collected from stool samples of inpatients performing active rectal screening for carbapenem-resistant Enterobacteriaceae during hospitalization in the ICUs of a tertiary hospital between 2016 and 2017. Among them, six KPC-producing CRKP isolates from three patients (two isolates for each patient) were identified with distinct antibacterial susceptibility. Our findings showed that: (1) blaKPC–2 gene is predominant in CRKP strains isolated from the intensive care patients and can be incorporated into various plasmids that are transmissible among multiple bacterial hosts in the human gastrointestinal tract; (2) the human gastrointestinal tract has a capacity to dynamically colonize multiple clones of CRKP strains with varied plasmids, diverse antimicrobial resistance genes and virulence genes. K. pneumoniae colonization is an important step in progression to extraintestinal infection, which provides the rationale for establishing intervention measures to prevent subsequent infection. Thus, close surveillance on CRKP colonization, together with effective infection prevention and control measures, should be put into practice.
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Affiliation(s)
- Qiao-Ling Sun
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Danxia Gu
- Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Clinical Research Institute, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qi Wang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yanyan Hu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Lingbin Shu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jie Hu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Rong Zhang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Gong-Xiang Chen
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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28
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Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodríguez-Baño J, Ruppé É, Salluh J, Taccone FS, Weiss E, Barbier F. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 2019; 45:172-189. [PMID: 30659311 DOI: 10.1007/s00134-019-05520-5] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.
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Affiliation(s)
- Jean-François Timsit
- Medical and Infectious Diseases ICU, APHP, Bichat-Claude Bernard Hospital, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France.
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France.
| | - Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Olaf Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George Daikos
- Scool of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Andre Kallil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric Kipnis
- Surgical Critical Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Lille, Lille, France
| | - Marin Kollef
- Critical Care Research, Washington University School of Medicine and Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Kevin Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, Canada
| | - Jose-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jesús Rodríguez-Baño
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Departament of Medicine, University of Sevilla, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Étienne Ruppé
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, IDOR, Rio De Janeiro, Brazil
| | | | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, AP-HP, Clichy, France
- INSERM, CRI, UMR 1149, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
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29
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Kontopoulou K, Iosifidis E, Antoniadou E, Tasioudis P, Petinaki E, Malli E, Metallidis S, Vatopoulos A, Malisiovas N. The clinical significance of carbapenem-resistant Klebsiella pneumoniae rectal colonization in critically ill patients: from colonization to bloodstream infection. J Med Microbiol 2019; 68:326-335. [PMID: 30688629 DOI: 10.1099/jmm.0.000921] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To highlight the clinical significance of carbapenem-resistant Klebsiella pneumoniae (CRKP) rectal colonization by examining the risk factors for CRKP rectal colonization and subsequent bloodstream infection (BSI) in critically ill patients. METHODOLOGY Prospective study of CRKP rectal colonization in an intensive care unit (ICU) during a 39-month period. CRKP strains isolated from both the blood cultures and corresponding rectal specimens (n=96) of patients were screened by PCR for the presence of antibiotic resistance-associated genes. Molecular analyses were conducted to investigate the clonal relatedness of CRKP strains from the rectal and blood specimens. RESULTS Among the 498 patients, 226 were rectally colonized by CRKP, 48 of whom developed a CRKP BSI. The median time from hospital admission to the detection of CRKP rectal colonization was 8 days, while the median time from colonization to BSI was 4 days. The duration of ICU stay, patient/nurse ratio and prior use of antianaerobic antimicrobials were associated with CRKP rectal colonization. No specific factor was associated with BSIs in the colonized patients. The blaKPC-2 gene was detected in all 96 strains, which were all classified as sequence type ST-258. Representative pairs (n=48) of CRKP strains colonizing and infecting the same patient shared the same pulsotype. CONCLUSION Our results indicate that hospitalized patients become infected with their colonizing strains, supporting the strong association between colonization and BSI. Limiting antianaerobic antimicrobial administration, reducing the duration of ICU stay and maintaining a low patient/nurse ratio are possible strategies to restrict rectal CRKP colonization in ICUs.
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Affiliation(s)
| | - Elias Iosifidis
- 2 3rd Department of Pediatrics, Hippokration Hospital, Aristotle University, Thessaloniki, Greece
| | | | | | - Efthymia Petinaki
- 4 Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | - Ergina Malli
- 4 Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | - Symeon Metallidis
- 5 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | | | - Nicolaos Malisiovas
- 7 Department of Microbiology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
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30
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Bar-Yoseph H, Cohen N, Korytny A, Andrawus ER, Even Dar R, Geffen Y, Hussein K, Paul M. Risk factors for mortality among carbapenem-resistant enterobacteriaceae carriers with focus on immunosuppression. J Infect 2018; 78:101-105. [PMID: 30312647 DOI: 10.1016/j.jinf.2018.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/30/2018] [Accepted: 10/06/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify risk factors for mortality in a cohort of carbapenem-resistant enterobacteriaceae (CRE) carriers, focusing on immunosuppression and other risk factors known at the time of CRE carriage detection. METHODS We prospectively followed all new and known CRE carriers admitted between June 2016 and June 2017 to a single tertiary center in Israel. Patients were included in the study after confirmation of the carrier state. Demographic and clinical data were documented on admission or CRE acquisition and patients were followed prospectively post-discharge until January 2018 or death. Risk factors for mortality known at the time of the first encounter with a CRE carrier were sought. Adjusted hazard ratios (HR) for mortality at end of follow-up with 95% confidence intervals (CI) were assessed using Cox regression analysis. RESULTS A total of 115 patients were included in the analysis. During the study period, 66 (57.4%) patients died. Immunosuppression was associated with mortality (HR 1.95, CI 95% 1.12-3.44), adjusted to the Charlson co-morbidity score, functional status, chronic renal disease and Klebsiella pneumonia CRE, the latter three also significantly associated with mortality. CRE bacteremia occurred among 24 (20.9%) carriers during follow up, more frequently among immunosuppressed patients and was significantly associated with mortality at end of follow-up (p = 0.015). CONCLUSION Immunosuppression is independently associated with mortality among CRE carriers, possibly related to CRE bacteremia that is frequent among these patients. Further research is needed on interventions to prevent deaths among CRE carriers.
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Affiliation(s)
- Haggai Bar-Yoseph
- Department of Gastroenterology, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, 8th Haalia Hashnia St., Haifa 3109601, Israel.
| | - Nadav Cohen
- Division of Infectious disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Alexander Korytny
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Elias R Andrawus
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Razi Even Dar
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yuval Geffen
- Microbiology Laboratory, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khetam Hussein
- Division of Infectious disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Division of Infectious disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Woerther PL, Lepeule R, Burdet C, Decousser JW, Ruppé É, Barbier F. Carbapenems and alternative β-lactams for the treatment of infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae: What impact on intestinal colonisation resistance? Int J Antimicrob Agents 2018; 52:762-770. [PMID: 30176355 DOI: 10.1016/j.ijantimicag.2018.08.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/14/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022]
Abstract
The ongoing pandemic of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is responsible for a global rise in carbapenem consumption that may hasten the dissemination of carbapenemase-producing Enterobacteriaceae (CPE). Hence, carbapenem sparing through the use of alternative β-lactams is increasingly considered as a potential option in patients with ESBL-E infections. However, at the individual level, this strategy implies an in-depth understanding of how carbapenems and their alternatives impair the gut microbiota, especially the anaerobic bacteria and the colonisation resistance (CR) that it confers. In this review, we sought to appraise the impact of carbapenems and their main alternatives for ESBL-E infections (namely β-lactam/β-lactamase inhibitor combinations, cephamycins and temocillin) on the gut ecosystem and the resulting hazard for acquisition of CPE. Although limited, the available evidence challenges our perception of the ecological side effects of these antimicrobials and highlights knowledge gaps regarding antibiotic-induced alterations in intestinal CR. These alterations may depend not only on anti-anaerobic properties but also on a panel of parameters with marked interindividual variability, such as baseline characteristics of the gut microbiota or the degree of biliary excretion for the considered drug. In the current context of ESBL-E dissemination and increasing opportunities for carbapenem-sparing initiatives, large, comparative, high-quality studies based on new-generation sequencing tools are more than ever warranted to better define the positioning of alternative β-lactams in antimicrobial stewardship programmes.
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Affiliation(s)
- Paul-Louis Woerther
- Department of Microbiology and Infection Control, Henri-Mondor Hospital, APHP, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, Paris-Est University, Créteil, France.
| | - Raphaël Lepeule
- Department of Microbiology and Infection Control, Henri-Mondor Hospital, APHP, Créteil, France
| | - Charles Burdet
- Diderot-Paris 7 University, Paris, France; INSERM, IAME, UMR 1137, Sorbonne-Paris Cité University, Paris, France; Department of Biostatistics, Epidemiology and Clinical Research, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Jean-Winoc Decousser
- Department of Microbiology and Infection Control, Henri-Mondor Hospital, APHP, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, Paris-Est University, Créteil, France
| | - Étienne Ruppé
- Diderot-Paris 7 University, Paris, France; INSERM, IAME, UMR 1137, Sorbonne-Paris Cité University, Paris, France; Department of Bacteriology, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
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Gong X, Zhang J, Su S, Fu Y, Bao M, Wang Y, Zhang X. Molecular characterization and epidemiology of carbapenem non-susceptible Enterobacteriaceae isolated from the Eastern region of Heilongjiang Province, China. BMC Infect Dis 2018; 18:417. [PMID: 30134844 PMCID: PMC6106938 DOI: 10.1186/s12879-018-3294-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to elucidate the molecular epidemiology of carbapenem non-susceptible Enterobacteriaceae(CNSE) isolated in the Eastern region of Heilongjiang Province, China, and the mechanism of carbapenem resistance. Methods A total of 53 CNSE isolates were collected in a grade-3 hospital in Heilongjiang province. Sensitivity to antibiotics was determined using the VITEK-2 Compact automatic system. The modified Hodge test (MHT) and modified carbapenem inactivation test (mCIM) were performed for phenotypic identification. Beta-lactamases gene were detected by Polymerase chain reaction(PCR) and DNA sequencing. The transfer of blaNDM and blaKPC was investigated through conjugation experiment. The clinical data of patients were retrospectively reviewed. Homology of Carbapenem-resistant Klebsiella pneumoniae(CRKP) was conducted by multilocus sequence typing (MLST). Results CNSE were highly resistant to the majority of antimicrobial agents. The resistance rate was 100% for first, third, fourth generation cephalosporins and enzyme inhibitor compounds. Gentamicin and tobramycin recorded a resistance rate higher than 80%. Less than 30% resistance was detected for amikacin and levofloxacin. Among CNSE 52(98.1%) and 48(90.6%) of CNSE were positive for mCIM and MHT respectively. There were 42 positive blaKPC genes, three blaNDM-1 genes, three blaNDM-5 genes, one blaNDM-7 gene, and six blaIMP-4 genes. Most isolates harbored multiple drug resistance gene, especially as related to extended-spectrum-β-lactamases, blaSHV, blaTEM and blaCTX-M-15 genes.The resistant gene was transferred into recipient Escherichia coli J53 through conjugation in 21.3% (10/47) of the strains. MLST revealed that ST76 (n = 36) was the most predominant clone, followed by ST896, ST323 and ST11. A new one ST 2946 was identity by this study. Conclusion The carbapenem resistance phenomenon is alarming and blaKPC-2 is the main resistant gene of CNSE in our hospital. This is the first report of an outbreak caused by blaKPC-2 positive K. pneumoniae ST76 in the Eastern region of Heilongjiang Province, China. Relevant departments should implement infection control and prevention measures to avoid further dissemination of the multi drug-resistant bacteria (MDR).
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Affiliation(s)
- Xue Gong
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Jisheng Zhang
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Shanshan Su
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Yanjun Fu
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Mingjia Bao
- Center for Disease Control and Prevention, Jiamusi, Heilongjiang, China
| | - Yong Wang
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China.
| | - Xiaoli Zhang
- Department of Microbiology, the First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China.
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Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand. Antimicrob Agents Chemother 2018; 62:AAC.00341-18. [PMID: 29891594 DOI: 10.1128/aac.00341-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/01/2018] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being Acinetobacter baumannii (n = 15), followed by Klebsiella pneumoniae (n = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (P = 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being A. baumannii (n = 28) and K. pneumoniae (n = 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube (P = 0.008) and administration of third-generation cephalosporins (P = 0.032) and carbapenems (P = 0.045). The most common carbapenemase genes in A. baumannii and K. pneumoniae were blaOXA-23/51 and blaNDM, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR A. baumannii (2 cases) and K. pneumoniae (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.
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Ray MJ, Trick WE, Lin MY. Assessing the Ability of Hospital Diagnosis Codes to Detect Inpatient Exposure to Antibacterial Agents. Infect Control Hosp Epidemiol 2018; 39:377-382. [PMID: 29460713 PMCID: PMC8383290 DOI: 10.1017/ice.2018.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Because antibacterial history is difficult to obtain, especially when the exposure occurred at an outside hospital, we assessed whether infection-related diagnostic billing codes, which are more readily available through hospital discharge databases, could infer prior antibacterial receipt. DESIGN Retrospective cohort study. PARTICIPANTS This study included 121,916 hospitalizations representing 78,094 patients across the 3 hospitals. METHODS We obtained hospital inpatient data from 3 Chicago-area hospitals. Encounters were categorized as "infection" if at least 1 International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code indicated a bacterial infection. From medication administration records, we categorized antibacterial agents and calculated total therapy days using Centers for Disease Control and Prevention (CDC) definitions. We evaluated bivariate associations between infection encounters and 3 categories of antibacterial exposure: any, broad spectrum, or surgical prophylaxis. We constructed multivariable models to evaluate adjusted risk ratios for antibacterial receipt. RESULTS Of the 121,916 inpatient encounters (78,094 patients) across the 3 hospitals, 24% had an associated infection code, 47% received an antibacterial, and 13% received a broad-spectrum antibacterial. Infection-related ICD-9-CM codes were associated with a 2-fold increase in antibacterial administration compared to those lacking such codes (RR, 2.29; 95% confidence interval [CI], 2.27-2.31) and a 5-fold increased risk for broad-spectrum antibacterial administration (RR, 5.52; 95% CI, 5.37-5.67). Encounters with infection codes had 3 times the number of antibacterial days. CONCLUSIONS Infection diagnostic billing codes are strong surrogate markers for prior antibacterial exposure, especially to broad-spectrum antibacterial agents; such an association can be used to enhance early identification of patients at risk of multidrug-resistant organism (MDRO) carriage at the time of admission. Infect Control Hosp Epidemiol 2018;39:377-382.
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Affiliation(s)
- Michael J. Ray
- Cook County Health and Hospitals System, Chicago, Illinois
| | - William E. Trick
- Cook County Health and Hospitals System, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
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You JH, Li HK, Ip M. Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis. Am J Infect Control 2018; 46:291-296. [PMID: 29103639 DOI: 10.1016/j.ajic.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). METHODS Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results. RESULTS Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold. CONCLUSIONS Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved.
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Corcione S, Angilletta R, Raviolo S, Filippini C, Fossati L, Di Perri G, Cavallo R, De Rosa FG. Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: A single center retrospective study. Eur J Intern Med 2018; 48:44-49. [PMID: 29096992 DOI: 10.1016/j.ejim.2017.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The incidence of C. difficile infection (CDI) and of bloodstream infection (BSI) caused by Candida spp., ESBL-E-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing K. pneumoniae (CP-Kp) is associated with high mortality. METHODS We conducted a single centre retrospective study on patients admitted to Molinette Hospital, Turin, Italy, from January 2013 to April 2015 with CDI or BSI caused by Candida, ESBL-E or CP-Kp. For each patient demographic, clinical and microbiological data were collected. Aims of this study were to describe epidemiology and to evaluate risk factors for in-hospital mortality in this group of patients. RESULTS Seven hundred-eighty six cases were analyzed: 398 CDI, 137 candidemia, 125 ESBL-E BSI and 126 CP-Kp BSI. CDI, candidemia and ESBL-E BSI were more frequently reported in internal medicine wards (IMW), whilst CP-Kp were more described in intensive care unit (ICU). Sixty-six percent of patients had a previous hospitalization and the majority of patients had several medical comorbidities. In-hospital death occurred in 23.4%. Independent risk factors for mortality were antibiotic therapy before hospital admission, cardiovascular diseases, neutropenia, urinary catheter, total parenteral nutrition, SIRS and higher creatinine levels at diagnosis. Previous abdominal surgery, inflammatory bowel disease, higher serum albumin levels at the admission and fever at diagnosis were significantly associated with survival. CONCLUSION Our data showed that CDI, ESBL-E BSI and candidemia are more frequent in frail patients, admitted to IMW, with chronic comorbidities and broad exposure to antibiotic therapies, with the exception for CP-Kp BSI, still more common in the ICU.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Stefania Raviolo
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Intensive Care Medicine, University of Turin, City of Health and Sciences, Molinette Hospital, Turin, Italy
| | - Lucina Fossati
- Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette Hospital, Turin, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, University of Turin, Laboratory of Microbiology and Virology, Turin, Italy
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van Loon K, Voor In 't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e01730-17. [PMID: 29038269 PMCID: PMC5740327 DOI: 10.1128/aac.01730-17] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are major health care-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE infection prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized the environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in the random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that the use of medical devices generated the highest pooled estimate (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67), followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions, including the use of barrier/contact precautions for patients colonized or infected with CRE, are needed. In addition, it is necessary to optimize the therapeutic approach, which is an important message to infectious disease specialists, who need to be actively involved in a timely manner in the treatment of patients with known CRE infections or suspected carriers of CRE.
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Affiliation(s)
- Karlijn van Loon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Pilmis B, Jullien V, Tabah A, Zahar JR, Brun-Buisson C. Piperacillin-tazobactam as alternative to carbapenems for ICU patients. Ann Intensive Care 2017; 7:113. [PMID: 29127502 PMCID: PMC5681454 DOI: 10.1186/s13613-017-0334-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/26/2017] [Indexed: 12/19/2022] Open
Abstract
Several studies suggest that alternatives to carbapenems, and particulary beta-lactam/beta-lactamase inhibitor combinations, can be used for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)-related infections in non-ICU patients. Little is known concerning ICU patients in whom achieving the desired plasmatic pharmacokinetic/pharmacodynamic (PK/PD) target may be difficult. Also, in vitro susceptibility to beta-lactamase inhibitors might not translate into clinical efficacy. We reviewed the recent clinical studies examining the use of BL/BLI as alternatives to carbapenems for therapy of bloodstream infection, PK/PD data and discuss potential ecological benefit from avoiding the use of carbapenems. With the lack of prospective randomized studies, treating ICU patients with ESBL-PE-related infections using piperacillin-tazobactam should be done with caution. Current data suggest that BL/BLI empirical use should be avoided for therapy of ESBL-PE-related infection. Also, definitive therapy should be reserved to patients in clinical stable condition, after microbial documentation and results of susceptibility tests. Optimization of administration and higher dosage should be used in order to reach pharmacological targets.
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Affiliation(s)
- Benoit Pilmis
- Service de maladies infectieuses et tropicales, Hôpital Necker Enfants malades, Service de maladies infectieuses et tropicales, Université Paris Descartes, Paris, France.,Equipe mobile de microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent Jullien
- Service de Pharmacologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France.,INSERM U1129, Paris, France
| | - Alexis Tabah
- Intensive Care Unit, The Redcliffe Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Jean-Ralph Zahar
- Département de Microbiologie Clinique, Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, CHU Avicenne, 125 rue de Stalingrad, 9300, Bobigny, France. .,Infection Control Unit, IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.
| | - Christian Brun-Buisson
- Réanimation médicale, Hôpital Henri Mondor, Université Paris Est Créteil (UPEC), Créteil, France
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McConville TH, Sullivan SB, Gomez-Simmonds A, Whittier S, Uhlemann AC. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PLoS One 2017; 12:e0186195. [PMID: 29023567 PMCID: PMC5638409 DOI: 10.1371/journal.pone.0186195] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an urgent public health threat. Intestinal colonization with CRE has been identified as a risk factor for the development of systemic CRE infection, but has not been compared to colonization with third and/or fourth generation cephalosporin-resistant (Ceph-R) Enterobacteriaceae. Moreover, the risk conferred by colonization on adverse outcomes is less clear, particularly in critically ill patients admitted to the intensive care unit (ICU). Methods We carried out a cohort study of consecutive adult patients screened for rectal colonization with CRE or Ceph-R upon ICU entry between April and July 2013. We identified clinical variables and assessed the relationship between CRE or Ceph-R colonization and subsequent systemic CRE infection within 30 days (primary outcome) and all-cause mortality within 90 days (secondary outcome). Results Among 338 ICU patients, 94 (28%) were colonized with either Ceph-R or CRE. 26 patients developed CRE infection within 30 days of swab collection; 47% (N = 17/36) of CRE-colonized and 3% (N = 2/58) of Ceph-R colonized patients. 36% (N = 13/36) of CRE-colonized patients died within 90 days compared to 31% (N = 18/58) of Ceph-R-colonized and 15% (N = 37/244) of non-colonized patients. In a multivariable analysis, CRE colonization independently predicted development of a systemic CRE infection at 30 days (aOR 10.8, 95% CI2.8–41.9, p = 0.0006); Ceph-R colonization did not (aOR 0.5, 95% CI0.1–3.3, p = 0.5). CRE colonization was associated with increased 90-day mortality in a univariable analysis (p-value 0.001), in a multivariable model, previous hospitalization and medical ICU admission were independent predictors of 90-day mortality whereas CRE colonization approached significance (aOR 2.3, 95% CI1.0–5.3, p = 0.056). Conclusions Our study highlights the increased risk of CRE infection and mortality in patients with CRE colonization at the time of ICU admission. Future studies are needed to assess how CRE colonization can guide empiric antibiotic choices and to develop novel decolonization strategies.
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Affiliation(s)
- Thomas Howe McConville
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
| | - Sean Berger Sullivan
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
| | - Angela Gomez-Simmonds
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
| | - Susan Whittier
- Department of Pathology and Cell Biology, Clinical Microbiology Laboratory, Columbia University Medical Center, New York, New York, United States of America
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
- * E-mail:
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Demiraslan H, Cevahir F, Berk E, Metan G, Cetin M, Alp E. Is surveillance for colonization of carbapenem-resistant gram-negative bacteria important in adult bone marrow transplantation units? Am J Infect Control 2017; 45:735-739. [PMID: 28214159 DOI: 10.1016/j.ajic.2017.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to investigate the rate of carbapenem-resistant gram-negative bacilli (CRGNB) colonization and to analyze the risk factors associated with CRGNB colonization. METHODS This prospective study was conducted in adult patients hospitalized in hematopoietic stem cell transplantation (HSCT) units over a period of 8 months. Rectal swab samples were obtained from each participant every Monday, and patients CRGNB positive on admission were excluded. RESULTS Of 185 participants, the median age was 47 years, and 59.5% were men. CRGNB colonization was detected in 21 (11.4%) patients. The most commonly isolated CRGNB were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Multivariate analysis revealed that busulfan use (11.9 times), fludarabine use (6.4 times), transfer from another hospital (7.8 times), transfer between units (9.3 times), and central venous catheterization (5.1 times) were risk factors for CRGNB colonization. During the study period, febrile neutropenia (FN) developed in 9 (56.2%) of the 21 colonized patients, and 1 patient died. CONCLUSIONS Screening of patients for CRGNB colonization may have a role in preventing the spread of CRGNB. However, the empirical antimicrobial treatment for FN in patients with CRGNB colonization did not change, and their mortality rates were similar.
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Affiliation(s)
- Hayati Demiraslan
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Melikgazi, Kayseri, Turkey.
| | - Fatma Cevahir
- Infection Control Committee, Erciyes University, Kayseri, Turkey
| | - Elife Berk
- Department of Medical Microbiology, Erciyes University, Kayseri, Turkey
| | - Gokhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, Turkey
| | - Mustafa Cetin
- Department of Hematology, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Melikgazi, Kayseri, Turkey; Infection Control Committee, Erciyes University, Kayseri, Turkey
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Abstract
There has been a dramatic increase in the last decade in the number of carbapenem-resistant Enterobacteriaceae, often leaving patients and their providers with few treatment options and resultant poor outcomes when an infection develops. The majority of the carbapenem resistance is mediated by bacterial acquisition of one of three carbapenemases (Klebsiella pneumoniae carbapenemase [KPC], oxacillinase-48-like [OXA-48], and the New Delhi metallo-β-lactamase [NDM]). Each of these enzymes has a unique global epidemiology and microbiology. The genes which encode the most globally widespread carbapenemases are typically carried on mobile pieces of DNA which can be freely exchanged between bacterial strains and species via horizontal gene transfer. Unfortunately, most of the antimicrobial surveillance systems target specific strains or species and therefore are not well equipped for examining genes of drug resistance. Examination of not only the carbapenemase gene itself but also the genetic context which can predispose a gene to mobilize within a diversity of species and environments will likely be central to understanding the factors contributing to the global dissemination of carbapenem resistance. Using the three most prevalent carbapenemase genes as examples, this chapter highlights the potential impact the associated genetic mobile elements have on the epidemiology and microbiology for each carbapenemase. Understanding how a carbapenemase gene mobilizes through a bacterial population will be critical for detection methods and ultimately inform infection control practices. Understanding gene mobilization and tracking will require novel approaches to surveillance, which will be required to slow the spread of this emerging resistance.
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Solgi H, Badmasti F, Aminzadeh Z, Giske CG, Pourahmad M, Vaziri F, Havaei SA, Shahcheraghi F. Molecular characterization of intestinal carriage of carbapenem-resistant Enterobacteriaceae among inpatients at two Iranian university hospitals: first report of co-production of bla NDM-7 and bla OXA-48. Eur J Clin Microbiol Infect Dis 2017. [PMID: 28639165 DOI: 10.1007/s10096-017-3035-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal colonization of carbapenem-resistant Enterobacteriaceae (CRE) could serve as a reservoir for the transmission of these pathogens in the clinical setting. The aim of this study was to investigate the intestinal carriage of CRE and to analyze risk factors for CRE carriage. Rectal swabs were collected from 95 patients at two Iranian university hospitals. CRE screening was performed using selective media (CHROMagar and MacConkey agar). Polymerase chain reaction (PCR) was used to detect carbapenemase-encoding genes. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE). The rate of carriage of CRE in hospitalized patients was 37.9%. Overall, 54 CRE isolates were identified, of which 47 were carbapenemase-producers. All of the 54 CRE were detected using CHROMagar compared with 52 CRE detected using MacConkey agar. Fifteen patients were colonized by multiple CRE isolates. Three significant risk factors for CRE carriage were detected: intensive care unit (ICU) hospitalization, antibiotic exposure, and mechanical ventilation. bla OXA-48 was the most frequent carbapenemase detected, followed by bla NDM-1 and bla NDM-7. Eleven carbapenemase-producing Enterobacteriaceae (CPE) isolates co-harbored bla NDM-1 and bla OXA-48. Also, six CPE isolates co-harbored bla NDM-7 and bla OXA-48. We did not detect bla KPC, bla GES, bla IMP, or bla VIM. PFGE analysis showed that Escherichia coli clones were diverse, while Klebsiella pneumoniae isolates were divided into four clusters. Cluster I was the major clone carrying bla OXA-48 and bla CTX-M-15 genes. In our study, the carriage rate of CRE was high and the emergence of CPE isolates among patients is alarming. The implementation of adequate preventive measures such as active surveillance is urgently needed to control the spread of CPE in the healthcare setting.
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Affiliation(s)
- H Solgi
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | - F Badmasti
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | - Z Aminzadeh
- Infectious Disease and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - C G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Pourahmad
- Infectious Diseases Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Vaziri
- Department of Tuberculosis and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | - S A Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Shahcheraghi
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran.
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Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients. Infect Control Hosp Epidemiol 2017; 38:670-677. [PMID: 28397615 DOI: 10.1017/ice.2017.62] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify modifiable risk factors for acquisition of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients. DESIGN Multicenter, matched case-control study. SETTING Four LTACHs in Chicago, Illinois. PARTICIPANTS Each case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay. RESULTS From June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01-1.04; P=.002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06-4.77; P=.04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01-1.29; P=.04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure. CONCLUSIONS Higher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population. Infect Control Hosp Epidemiol 2017;38:670-677.
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A Novel Risk Factor Associated With Colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in Addition to Antimicrobial Treatment. Infect Control Hosp Epidemiol 2016; 37:1418-1425. [PMID: 27619653 DOI: 10.1017/ice.2016.202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVETo study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).METHODSWe analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.RESULTSOf 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).CONCLUSIONSConcomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.Infect Control Hosp Epidemiol 2016;1418–1425
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Yang D, Xie Z, Xin X, Xue W, Zhang M. A model for predicting nosocomial carbapenem-resistant Klebsiella pneumoniae infection. Biomed Rep 2016; 5:501-505. [PMID: 27699021 DOI: 10.3892/br.2016.752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/11/2016] [Indexed: 01/11/2023] Open
Abstract
Mortality associated with infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) is high and the infections need to be predicted early. The risk factors for CR-KP infection are heterogeneous. The aim of the present study was to construct a model allowing for the early prediction of CR-KP infection. Nosocomial infections due to K. pneumoniae were evaluated retrospectively over a 2-year period. The case cohort consisted of 370 inpatients with CR-KP infection. For each case enrolled, two matched controls with no CR-KP infection during their hospitalization were randomly selected. Matching involved month of admission, ward, as well as interval days. The Vitek 2 system was used for identification of isolates and antimicrobial susceptibility testing. General linear model with logistic regression was used to identify possible risk factors. The predicted power of the model was expressed as the area under the receiver-operating characteristic curve. Age, male gender, with cardiovascular disease, hospital stay, recent admission to intensive care unit, indwelling urinary catheter, mechanical ventilation, recent β-lactam-β-lactamase inhibitors, fourth-generation cephalosporins and/or carbapenems therapy were independent risk factors for CR-KP infection. Models predicting CR-KP infection developed by cumulative risk factors exhibited good power, with areas under the receiver-operating characteristic curves of 0.902 [95% confidence interval (CI), 0.883-0.920; P<0.001] and 0.899 (95% CI, 0.877-0.921; P<0.001) after filtering by age (≥70 years). The Yonden index was at the maximum when the cumulative risk factors were ≥3 in the two prediction models. The results show that the prediction model developed in the present study might be useful for controlling infections caused by CR-KP strains.
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Affiliation(s)
- Duo Yang
- Central Laboratory, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, P.R. China
| | - Zeqiang Xie
- Clinical Laboratory, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, P.R. China
| | - Xuli Xin
- Clinical Laboratory, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, P.R. China
| | - Wenying Xue
- Hospital Infection Management Office, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, P.R. China
| | - Man Zhang
- Clinical Laboratory, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, P.R. China
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Haverkate MR, Weiner S, Lolans K, Moore NM, Weinstein RA, Bonten MJM, Hayden MK, Bootsma MCJ. Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois. Open Forum Infect Dis 2016; 3:ofw178. [PMID: 27747253 PMCID: PMC5063543 DOI: 10.1093/ofid/ofw178] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
Abstract
Knowledge of the duration of colonization with KPC is essential for infection control measures. We found that only 17% of LTACH patients lost colonization within four weeks. Half of the KPC-positive patients were still carriers when readmitted after nine months. Background. High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods. We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account. Results. Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91–∞). Conclusions. Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs.
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Affiliation(s)
- Manon R Haverkate
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Medicine, Division of Infectious Diseases, Rush University Medical Center
| | - Shayna Weiner
- Department of Medicine, Division of Infectious Diseases, Rush University Medical Center
| | - Karen Lolans
- Department of Pathology , Rush University Medical Center
| | | | - Robert A Weinstein
- Department of Medicine, Division of Infectious Diseases, Rush University Medical Center; Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Medical Microbiology, University Medical Center Utrecht
| | - Mary K Hayden
- Department of Medicine, Division of Infectious Diseases, Rush University Medical Center; Department of Pathology, Rush University Medical Center
| | - Martin C J Bootsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Mathematics, Utrecht University, the Netherlands
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Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients. Infect Control Hosp Epidemiol 2016; 37:1219-25. [PMID: 27452597 DOI: 10.1017/ice.2016.153] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient. METHODS A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression. RESULTS In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition. CONCLUSIONS Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study. Infect Control Hosp Epidemiol 2016;1-7.
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Tuon FF, Aragao BZD, Santos TA, Gasparetto J, Cordova K, Abujamra M. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond) 2016; 48:869-71. [PMID: 27389520 DOI: 10.1080/23744235.2016.1205215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Felipe Francisco Tuon
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Bruna Zanette de Aragao
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Thiago Almeida Santos
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Juliano Gasparetto
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Kassia Cordova
- b Department of Medicine , Faculdade Evangélica do Paraná , Curitiba , Brazil
| | - Marcela Abujamra
- b Department of Medicine , Faculdade Evangélica do Paraná , Curitiba , Brazil
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Torres-González P, Ortiz-Brizuela E, Cervera-Hernandez ME, Bobadilla-Del Valle M, Martínez-Gamboa A, Sifuentes-Osornio J, Ponce-de-Leon A. Associated factors and outcomes for OXA-232 Carbapenem-resistant Enterobacteriaceae infections in a tertiary care centre in Mexico City: A case-control-control study. Diagn Microbiol Infect Dis 2016; 86:243-8. [PMID: 27519297 DOI: 10.1016/j.diagmicrobio.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 01/16/2023]
Abstract
We describe the outcomes and factors associated with OXA-232 producing carbapenem-resistant Enterobacteriaceae infections. A case-control-control study was performed; each case of infection by a carbapenem-resistant/OXA-232 (OXA-232-cases, n=27) was matched by isolation site, species, and date, with 2 cases of infection by carbapenem-susceptible/third-generation cephalosporin-susceptible (TGCS-controls, n=54) and 2 cases by carbapenem-susceptible/ESBL producing Enterobacteriaceae (ESBL-controls, n=54); 66% were urinary tract and 18.5% intra-abdominal infections. In the multivariable analysis with ESBL-controls, previous use β-lactam/β-lactamase antibiotics (OR 6.2; 95% CI 1.6-23.8) and, third-generation cephalosporins (OR 0.2; 95% CI 0.05-0.8) were associated with OXA-232 infection; with TGSC-controls previous use of β-lactam/β-lactamase antibiotics (OR 3.7; 95% 1.1-12.0) was associated. Among the OXA-232-cases, 29% received imipenem/cilastatin or meropenem, 11.1% ceftriaxone, 22.2% a carbapenem-based combination and 33.3% other antimicrobials as treatment. Previous β-lactam/β-lactamase antibiotics are associated with OXA-232 infections, and some may be treated with other active carbapenems or, in the absence of ESBL, third-generation cephalosporins.
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Affiliation(s)
- Pedro Torres-González
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - Edgar Ortiz-Brizuela
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - Miguel Enrique Cervera-Hernandez
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - Miriam Bobadilla-Del Valle
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - Areli Martínez-Gamboa
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico
| | - Alfredo Ponce-de-Leon
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Mexico City, Mexico.
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Bar-Yoseph H, Hussein K, Braun E, Paul M. Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother 2016; 71:2729-39. [PMID: 27317444 DOI: 10.1093/jac/dkw221] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ESBL-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae (CRE) are rapidly spreading worldwide. Their natural reservoir is intestinal. METHODS We carried out a systematic review and meta-analysis to estimate CRE and ESBL carriage duration and to evaluate the effect of decolonization therapy. We included cohort and comparative studies examining the natural history of CRE/ESBL colonization, examining rates of carriage following decolonization or comparing decolonization and no decolonization conducted in the healthcare setting or in the community. A comprehensive search was conducted until November 2015. We compiled carriage rates at 1, 3, 6 and 12 months with and without decolonization therapy and assessed the effect of decolonization. RESULTS Thirty-seven studies fulfilled inclusion criteria. In healthcare settings, pooled ESBL/CRE colonization rates decreased without intervention from 76.7% (95% CI = 69.3%-82.8%) at 1 month to 35.2% (95% CI = 28.2%-42.9%) at 12 months of follow-up. Following decolonization, the rate was 37.1% (95% CI = 27.5%-47.7%) at end of therapy and 57.9% (95% CI = 43.1%-71.4%) at 1 month. In two randomized trials, carriage was significantly reduced at end of therapy (risk ratio = 0.42, 95% CI = 0.25-0.65), but the effect was not significant after 1 month (risk ratio = 0.72, 95% CI = 0.48-1.05), with no longer follow-up. Heterogeneity was explained by surveillance methodology, with no differences observed between ESBLs and CREs. Among community dwellers, ESBL colonization decreased from 52.3% (95% CI = 29.5%-74.2%) at 1 month to 19.2% (95% CI = 9.7%-34.4%) at 6 months. CONCLUSIONS A significant proportion of ESBL and CRE carriers remain colonized up to 1 year in the healthcare setting. While short-term decolonization therapy reduces carriage during therapy, its longer-term effects are unclear.
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Affiliation(s)
- Haggai Bar-Yoseph
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khetam Hussein
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Braun
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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