scholarly journals Risk Factors for Carbapenemase Producing-Carbapenem Resistant Enterobacteriaceae in Those With CRE Positive Cultures

2020 ◽  
Vol 41 (S1) ◽  
pp. s376-s377
Author(s):  
Geneva Wilson ◽  
Christopher Pfeiffer ◽  
Margaret Fitzpatrick ◽  
Katie Suda ◽  
Brian Bartle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Geographic Region ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are gram-negative bacteria resistant to at least 1 carbapenem and are associated with high mortality (50%). Carbapenemase-producing CRE (CP-CRE) are particularly serious because they are more likely to transmit carbapenem resistance genes to other gram-negative bacteria and they are resistant to all carbapenem antibiotics. Few studies have evaluated risk factors associated with CP-CRE colonization. The goal of this study was to determine the risk factors associated with CP-CRE colonization in a cohort of US veterans. Methods: We conducted a retrospective cohort study of patients seen at VA medical centers between 2013 and 2018 who had positive cultures for CRE from any site, defined by resistance to at least 1 of the following carbapenems: imipenem, meropenem, doripenem, or ertapenem. CP-CRE was defined via antibiotic sensitivity data that coded the culture as being ‘carbapenemase producing,’ being ‘Hodge test positive,’ or ‘KPC producing.’ Only the first positive culture for CRE was included. Patient demographics (year of culture, age, sex, race, major comorbidities, infectious organism, culture site, inpatient status, and CP-CRE status) and facility demographics (rurality, geographic region, and facility complexity) were collected. Bivariate analysis and multiple logistic regression were performed to determine variables associated with CP-CRE versus non–CP-CRE. Results: In total, 3,322 patients were identified with a positive CRE culture: 546 (16.4%) with CP-CRE and 2,776 (83.63%) with non–CP-CRE. Most patients were men (95%) and were older (mean age, 71; SD, 12.5) and were diagnosed at a high-complexity VA medical center (65%). Most of the cultures were urine (63%), followed by sputum (13%), and blood (7%). Most were from inpatients (46%), followed by outpatients (42%), and long-term care facilities (12%). Multivariable analysis showed the following variables to be associated with CP-CRE positive cultures: congestive heart failure (P = .0136), African American (P = .0760), Klebsiella spp (P < .0001), GI cancers (P = .0087), culture collected in 2017 (P = .0004), and culture collected in 2018 (P < .0001). There were also significant differences CP-CRE frequencies by geographic region (P < .001). Discussion: CP-CRE diagnoses are relatively rare; however, the serious complications associated make them important infections to investigate. In our analysis, we found that congestive heart failure and gastric cancer were comorbidities strongly associated with CP-CRE. In 2017, the VA formalized their CP-CRE definition, which led to more accurate reporting. Conclusions: After the guideline was implemented, CP-CRE detection dramatically increased in noncontinental US facilities. More work should be done in the future to determine the different risk factors between non–CP-CRE and CP-CRE infections.Funding: NoneDisclosures: None

scholarly journals Active Surveillance of Carbapenem-resistant Gram-negative Bacteria to guide antibiotic therapy: a single-center prospective observational study

2021 ◽  
Author(s):  
Qiqiang Liang ◽  
Juan Chen ◽  
Yongshan Xu ◽  
Yibing Chen ◽  
Man Huang
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Antibiotic Therapy ◽  
Prospective Observational Study ◽  
Gram Negative Bacteria ◽  
Empirical Antibiotic Therapy ◽  
Single Center ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant Gram-negative Bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. Methods A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. Results 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). Conclusions CRGNB colonization increased the risk of infection, and risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, susceptibility-guided antibiotic treatment can be given according to previous susceptibility results of colonized CRGNB, reducing mortality.

Risk factors associated with the isolation of colistin-resistant Gram-negative bacteria: A matched case-control study

2008 ◽  
Vol 36 (3) ◽  
pp. 807-811 ◽  
Author(s):  
Dimitrios K. Matthaiou ◽  
Argyris Michalopoulos ◽  
Petros I. Rafailidis ◽  
Drosos E. Karageorgopoulos ◽  
Vassiliki Papaioannou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Factors Associated ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

scholarly journals Risk Factors Associated With Imipenem-Resistance Among Isolated Gram -Negative Bacteria From Patients in Sanandaj Hospitals, Iran

2016 ◽  
Vol 3 (1) ◽  
pp. 29989-29989
Author(s):  
Behzad Mohsenpour ◽  
Samaneh Rouhi ◽  
Roghaye Mehrdel ◽  
Tayyebe Faraji ◽  
Milad Masaeli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Factors Associated ◽  
Imipenem Resistance

scholarly journals Epidemiology and Risk Factors Associated With Mortality in Consecutive Patients With Bacterial Bloodstream Infection: Impact of MDR and XDR Bacteria

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Antonella Santoro ◽  
Erica Franceschini ◽  
Marianna Meschiari ◽  
Marianna Menozzi ◽  
Stefano Zona ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Condition ◽  
Gram Negative Bacteria ◽  
Charlson Score ◽  
Patient Death ◽  
Gram Negative ◽  
Factors Associated ◽  
Risk Of Death ◽  
Crude Mortality ◽  
Independent Risk Factors

Abstract Background  Mortality related to bloodstream infections (BSIs) is high. The epidemiology of BSIs is changing due to the increase in multidrug resistance, and it is unclear whether the presence of multidrug-resistant (MDR) organisms, per se, is an independent risk factor for mortality. Our objectives were, first, to describe the epidemiology and outcome of BSIs and, second, to determine the risk factors associated with mortality among patients with BSI. Methods  This research used a single-center retrospective observational study design. Patients were identified through microbiological reports. Data on medical history, clinical condition, bacteria, antimicrobial therapy, and mortality were collected. The primary outcome was crude mortality at 30 days. The relationships between mortality and demographic, clinical, and microbiological variables were analyzed by multivariate analysis. Results  A total of 1049 inpatients were included. MDR bacteria were isolated in 27.83% of patients, where 2.14% corresponded to an extremely drug-resistant (XDR) isolate. The crude mortality rates at days 7, 30, and 90 were 12.11%, 25.17%, and 36.13%, respectively. Pitt score &gt;2, lung and abdomen as site of infection, and XDR Pseudomonas aeruginosa were independent risk factors for 7-, 30-, and 90-day mortality. Charlson score &gt;4, carbapenem-resistant Klebsiella pneumoniae, and XDR Acinetobacter baumannii were independent risk factors for 30- and 90-day mortality. Infection by XDR gram-negative bacteria, Charlson score &gt;4, and immunosuppression were independent risk factors for mortality in patients who were stable at the time of BSI. Conclusions  BSI is an event with an extreme impact on mortality. Patients with severe clinical condition are at higher risk of death. The presence of XDR gram-negative bacteria in blood is strongly and independently associated with patient death.

scholarly journals A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Claudia M. D. de Maio Carrilho ◽  
Larissa Marques de Oliveira ◽  
Juliana Gaudereto ◽  
Jamile S. Perozin ◽  
Mariana Ragassi Urbano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Factors Associated ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
A Prospective Study ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals IS26 mediate the acquisition of tigecycline resistance gene cluster tmexCD1-toprJ1 by IncHI1B-FIB plasmids in Klebsiella pneumoniae and Klebsiella quasipneumoniae from food market sewage

2020 ◽  
Author(s):  
Miao Wan ◽  
Xun Gao ◽  
Luchao Lv ◽  
Zhongpeng Cai ◽  
Jian-Hua Liu
Keyword(s):  
Klebsiella Pneumoniae ◽  
Gene Cluster ◽  
Resistance Gene ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Resistance Gene Cluster ◽  
Carbapenem Resistant ◽  
Food Market ◽  
Carbapenem Resistant Enterobacteriaceae

Tigecycline and colistin are considered 20 as the final options for the treatment of infections caused by multidrug-resistant (MDR) gram-negative bacteria, especially carbapenem-resistant Enterobacteriaceae (1).…

scholarly journals A Comparative Study of the Microbiological Efficacy of Polymyxin B on Different Carbapenem-Resistant Gram-Negative Bacteria Infections

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiong Lu ◽  
Hai-Hong Zhu ◽  
Guo-Hua Li ◽  
Ting-Ting Qi ◽  
Liang-Jun Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Clearance Rate ◽  
Bacterial Species ◽  
Polymyxin B ◽  
Gram Negative Bacteria ◽  
Bacterial Clearance ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Independent Risk Factors

Objective: The emergence of carbapenem-resistant gram-negative bacteria (CR-GNB) has brought great challenges to clinical anti-infection treatment around the world. Polymyxins are often considered as the last line of defense in the treatment of CR-GNB infections. In this study, we explored the microbiological efficacy of Polymyxin B (PMB) on different CR-GNB infections as well as the factors influencing microbiological efficacy.Methods: CR-GNB infected patients with PMB-based regimens were enrolled. Clinical and microbiological data were collected from the medical electronic record system of the Second Xiangya hospital. The efficacy of PMB on different CR-GNB was evaluated by the clearance rate at 7-days and within the course of treatment, as well as the 30-day mortality rate.Results: A total of 294 CR-GNB infected patients were enrolled: 154 CR-Acinetobacter baumannii (CRAB), 55 CR-Klebsiella pneumoniae (CRKP), and 85 CR-Pseudomonas aeruginosa (CRPA). The CRAB group had the highest 7-day bacterial clearance rate [(CRAB: 39.0%) vs. (CRKP: 29.4%) vs. (CRPA: 14.5%), P = 0.003] and total bacterial clearance rate [(CRAB: 49.0%) vs. (CRKP: 39.8%) vs. (CRPA: 18.2%), P &lt; 0.001] among the three groups, while the bacterial clearance rate of the CRPA group was the lowest. Multivariate logistic regression showed that the differences among the three groups were multiple CR-GNB infections (P = 0.004), respiratory infections (P = 0.001), PMB resistance (P &lt; 0.001), and the combination of tigecycline (P &lt; 0.001). Binary logistic regression showed that multiple CR-GNB infection [(7-day bacterial clearance: P = 0.004) &amp; (total bacterial clearance: P = 0.011)] and bacterial species [(7-day bacterial clearance: P &lt; 0.001) &amp; (total bacterial clearance: P &lt; 0.001)] were independent risk factors for microbiological efficacy.Conclusion: PMB exhibited differential microbiological efficacy on different types of CR-GNB infections; it had the best effect on CRAB, followed by CRKP and CRPA. Multiple CR-GNB infections and bacterial species were independent risk factors for microbiological efficacy.

scholarly journals 506. Urinary Catheters Are Associated with Progression from Bacteriuria to Invasive Infections in Patients with Carbapenem-Resistant Enterobacteriaceae, Metropolitan Atlanta, 2011–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S245-S246
Author(s):  
Jessica Howard-Anderson ◽  
Chris W Bower ◽  
Gillian Smith ◽  
Mary Elizabeth Sexton ◽  
Sarah W Satola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Catheter ◽  
Decubitus Ulcer ◽  
Invasive Infection ◽  
Urinary Catheters ◽  
Term Care ◽  
Carbapenem Resistant ◽  
Sterile Site ◽  
One Year ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Patients with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria have better outcomes than patients with an invasive CRE infection, but patients with bacteriuria may subsequently develop an invasive infection (“progression”). We sought to evaluate risk factors, particularly urinary catheters, for progression from CRE bacteriuria to an invasive CRE infection within one year. Methods We used population-based active surveillance data from the Georgia Emerging Infections Program to identify patients in metropolitan Atlanta with CRE in urine, but not in a concomitant or previous sterile site between August 1, 2011 and July 31, 2017. CRE was defined as an isolate resistant to tested third-generation cephalosporins and a minimum inhibitory concentration of ≥4 µg/mL for meropenem, doripenem or imipenem. We then assessed if these patients developed an invasive CRE infection (positive sterile site culture) with the same organism between one day and one year later. Demographics, culture site, comorbidities, and risk factors were obtained by chart review. Univariable analyses and multivariable logistic regression with progression as the outcome were performed in SAS 9.4. Results We identified 551 patients with CRE bacteriuria in 6 years, with an annual incidence of 1.1 cases/100,000 population. Many patients previously resided in long-term care facilities (48%), had a Charlson comorbidity index (CCI) >3 (38%), a central venous catheter (CVC, 34%) or a decubitus ulcer (27%, Table 1). Twenty-five patients (5%) progressed from CRE bacteriuria to an invasive CRE infection within one year (median 34 days). Predictors of progression in univariable analyses included the presence of a urinary catheter (OR 6.4 [95% CI: 1.9–21.6]), decubitus ulcer, CVC or other indwelling device, Klebsiella pneumoniae, black race, CCI >3, and ICU stay after urine culture was obtained (Table 2). In a multivariable analysis, urinary catheter (OR 4.6 [95% CI: 1.3–16.1]) predicted progression as well as K. pneumoniae, CCI >3 and CVC. Conclusion Progression from CRE bacteriuria to an invasive CRE infection is rare but clinically significant and is associated with urinary catheters. Future interventions should target urinary catheter removal, where possible, in patients with CRE bacteriuria. Disclosures All authors: No reported disclosures.

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