Comparison between IMP carbapenemase-producing Enterobacteriaceae and non-carbapenemase-producing Enterobacteriaceae: a multicentre prospective study of the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae

2019 ◽  
Vol 75 (3) ◽  
pp. 697-708
Author(s):  
Kayoko Hayakawa ◽  
Ryuichi Nakano ◽  
Ryota Hase ◽  
Michitsugu Shimatani ◽  
Hideaki Kato ◽  
...  
Keyword(s):  
Care Facility ◽  
Length Of Hospital Stay ◽  
Weighting Method ◽  
Term Care ◽  
Long Term Care Facility ◽  
Carbapenem Resistant ◽  
Public Health Reporting ◽  
Hospital Stays ◽  
Prolonged Hospital ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase. Objectives We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE. Methods Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis. Results Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group. Conclusions IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE.

scholarly journals 496. Carbapenem-resistant Enterobacter: A Case-Case–Control Investigation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S242-S242
Author(s):  
Leore Cohen Mendel ◽  
David Katz ◽  
Tsilia Lazarovitch ◽  
Ronit Zaidenstein ◽  
Dror Marchaim
Keyword(s):  
Cox Regression ◽  
Clinical Epidemiology ◽  
Medical Center ◽  
Care Facility ◽  
Case Control ◽  
World Health ◽  
Term Care ◽  
Long Term Care Facility ◽  
Carbapenem Resistant ◽  
Matched Design

Abstract Background. Background The World Health Organization has declared carbapenem-resistant Enterobacteriaceae (CRE) as a worldwide public health threat. Analyzing the epidemiology of CRE was derived from cohorts consisting primarily of Klebsiella pneumoniae isolates. The second most frequent CRE is Enterobacter (CREn), but its molecular and clinical epidemiology differ from that of K. pneumoniae, and it has not been analyzed while implementing updated methodological tools and design. Methods A matched case-case–control investigation was conducted at Shamir (Assaf Harofeh) Medical Center, Israel, for calendar years 2007–2017. Each CREn case was matched to a carbapenem-susceptible Enterobacter (CSEn) case and to an uninfected control (1:1:1 ratio). Logistic and Cox regression-matched analyses were conducted in order to study predictors and outcomes of CREn colonization and/or infection, respectively. Results The study included 216 cases (72 in each group). Numerous predictors were significantly associated with CREn as per bivariable analyses, but the only independent significant predictors were: (1) recent (3 months) exposure to fluoroquinolones (aOR=2.94, P = 0.04), (2) intensive care unit stay in current hospitalization prior to culture (aOR=3.56, P = 0.003), and (3) a rapidly fatal McCabe score (aOR=0.471, P = 0.01). Patients with CREn suffered from significant delays in instituting appropriate antimicrobials (P = 0.03), and for those who survived the hospitalization, were more frequently discharged to a long-term care facility after being admitted to the index hospitalization from home (aOR=3.3, P = 0.02). Conclusion This case-case–control-matched investigation of CREn epidemiology, revealed a unique modifiable predictor, i.e., recent fluoroquinolone exposure, which could represent a target for stewardship intervention. The case-case–control-matched design allowed for the control of numerous confounders previously reported to be associated with CREn but may represent a risk factor for Enterobacter infection in general. As with other CRE, CREn carriers suffer from significant delays in initiation of appropriate antimicrobials and from worse outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

2015 ◽  
Vol 53 (9) ◽  
pp. 2823-2826 ◽  
Author(s):  
Vincent J. LaBombardi ◽  
Carl M. Urban ◽  
Barry N. Kreiswirth ◽  
Liang Chen ◽  
Giuliana Osorio ◽  
...  
Keyword(s):  
Long Term Care ◽  
Agar Plate ◽  
Care Facility ◽  
Resistant Bacteria ◽  
Term Care ◽  
Content Type ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Carbapenem Resistant

We compared the Remel Spectra CRE agar plate to CDC standard methodology for the isolation of carbapenem-resistantEnterobacteriaceae(CRE) from 300 rectal swab specimens obtained from patients residing in a long-term-care facility (LTCF). Multiplex PCR experiments were performed on isolates to identify specificKlebsiella pneumoniaecarbapenemases (KPC) and additional β-lactamases. Of the 300 patients, 72 (24%) harbored CRE and were PCR positive for KPC enzymes. The Remel Spectra CRE plates detected KPC-type CRE in isolates from 70 of 72 patients (97.2%), while the CDC method detected CRE in 56 of 72 (77.8%). CRE identification results were available in 18 h compared to 36 h for the CDC method. Remel Spectra CRE agar plates can provide useful means for a fast and reliable method for detecting KPC-type CRE and for accelerated institution of appropriate infection control precautions.

scholarly journals Carbapenem-Resistant Enterobacteriaceae Resistant Only to Ertapenem: An Epidemiologically Distinct Cohort, Atlanta, 2016–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s463-s464
Author(s):  
Chris Bower ◽  
Max Adelman ◽  
Jessica Howard-Anderson ◽  
Uzma Ansari ◽  
Joseph Lutgring ◽  
...  
Keyword(s):  
Public Health ◽  
Clinical Laboratory ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Vital Statistics ◽  
Emerging Infections ◽  
Term Care ◽  
Convenience Sample ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE), particularly carbapenemase-producing (CP) CRE, pose a major public health threat. In 2016, the phenotypic definition of CRE expanded to include ertapenem resistance to improve sensitivity for detecting CP-CRE. We compared characteristics of CRE resistant to ertapenem only (CRE-EO) to CRE resistant to ≥1 other carbapenem (CRE-O). Methods: The Georgia Emerging Infections Program performs active, population-based CRE surveillance in metropolitan Atlanta. CRE cases were defined as any Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. variicola, Enterobacter cloacae complex, or Enterobacter aerogenes resistant to ≥1 carbapenem by the clinical laboratory and isolated from urine or a sterile site between 2016 and 2018. Data were extracted from retrospective chart review and 90-day mortality from Georgia vital statistics for 2016–2017. Polymerase chain reaction (PCR) for carbapenemase genes was performed on a convenience sample of isolates by the CDC or Georgia Public Health Laboratory. We compared characteristics of CRE-EO cases to CRE-O cases using χ2 tests or t tests. Results: Among 927 CRE isolates, 553 (60%) were CRE-EO. CRE-EO were less frequently isolated from blood (5% vs 12%; P < .01) and less commonly K. pneumoniae (21% vs 58%; P < .01) than CRE-O. CRE-EO cases were more often women (65% vs 50%; P < .01), had a lower Charlson comorbidity index (mean ± SD, 2.4±2.3 vs 3.0±2.6; P < .01), and were less commonly at a long-term care facility (24% vs 31%) or hospital (15% vs 21%; P < .01) in the 4 days prior to the CRE culture. CRE-EO were more susceptible to all antibiotics tested at the clinical laboratory (P < .01) except for tigecycline (P = 1.0) (Table 1). Of the 300 (32%) isolates tested for carbapenemase genes, 98 (33%) were positive (7% CRE-EO vs 62% CRE-O; P < .01). Of the CP isolates, we identified blaKPC in 93 cases (95%), blaNDM in 3 cases (3%), blaOXA-48-like in 2 cases (2%). CRE-EO cases had lower 90-day mortality (13% vs 21%; P < .01). Conclusions: CRE-EO are epidemiologically distinct from CRE-O and are less likely to harbor carbapenemase genes. CRE-EO may require less intensive infection prevention interventions and have more therapeutic options.Funding: NoneDisclosures: None

The epidemiology of carbapenem resistant Enterobacter spp: A case–case–control matched analysis

2020 ◽  
pp. 1-6
Author(s):  
Leore Cohen Mendel ◽  
Keren Amity ◽  
David E. Katz ◽  
Tsilia Lazarovitch ◽  
Ronit Zaidenstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Long Term Care ◽  
Care Facility ◽  
Case Control ◽  
Term Care ◽  
Long Term Care Facility ◽  
Recent Exposure ◽  
Carbapenem Resistant

Abstract A case–case–control investigation (216 patients) examined the risk factors and outcomes of carbapenem-resistant Enterobacter (CR-En) acquisition. Recent exposure to fluoroquinolones, intensive care unit (ICU) stay, and rapidly fatal McCabe condition were independent predictors for acquisition. Acquiring CR-En was independently associated with discharge to a long-term care facility after being admitted from home.

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