Carbapenem Resistance In Enterobacteriaceae Research Articles

2266. Management of Ertapenem-Resistant, Meropenem-Susceptible Enterobacteriaceae

BackgroundCarbapenemases are the most frequent mechanism of carbapenem resistance in Enterobacteriaceae. However, alternative mechanisms such as loss of porin channels or up-regulation of efflux pumps can cause intermediate- to high-level resistance to ertapenem (ERTA) and possibly reduced susceptibilities to meropenem (MERO) leading to discordant phenotypic profiles. Clinical implications of discordant carbapenem susceptibilities and optimal therapy options are yet unknown. We sought to describe our experience with carbapenem-discordant Enterobacteriaceae (CDE).MethodsDescriptive study of hospitalized adult patients with a CDE positive culture from December 1/16 - December 1/18. Discordance was defined as Enterobacteriaceae with an ERTA-resistant and MERO-susceptible phenotype. Primary objective was to describe antibiotic use patterns for CDE infections. Secondary outcomes included infectious diseases (ID) involvement and clinical outcomes. Clinical failure was defined as a composite of in-hospital mortality, switch of definitive therapy due to clinical worsening, re-hospitalization within 30 days for re-infection, or failure to achieve blood culture clearance for ≥7 days.ResultsA total of 55 patients with CDE were identified. Most common organisms were Enterobacter cloacae complex (72%) and Klebsiella pneumoniae (9%). Of 21 isolates tested, 1 (4.8%) was positive for a carbapenemase. Mean age of patients was 61 ± 16 years, 51% were admitted to a medicine service, and 18% were immunocompromised. ID was involved in 82% of CDE cases. Most common sites were urine (33%), wound/tissue (27%), and respiratory (18%). 43/55 (78%) patients were treated – 17/43 (40%) with MERO, 14/43 (33%) with fluoroquinolones. Ceftazidime/avibactam and tigecycline were used in 4 (9%) patients each. Combination therapy was used in 8 (19%) patients, most commonly with MERO or tigecycline. Clinical failure occurred in 21/43 (49%) patients – 8/43 (19%) were receiving MERO-based therapy, 13/43 (30%) were receiving a non-MERO-based therapy.ConclusionDiscordance between ERTA and MERO susceptibility was more common in Enterobacter spp. Majority of isolates tested negative for a carbapenemase. MERO and fluoroquinolones were the most frequently used antibiotics for treatment of CDE infections.Disclosures All authors: No reported disclosures.

499. Carbapenem-resistant Enterobacteriaceae (CRE)-associated Infections and Prolonged Colonization among Hospitalized Patients Colonized by CRE

BackgroundThis study aims to determine rates of subsequent carbapenem-resistance Enterobacteriaceae (CRE)-associated infections and prolonged colonization among patients colonized by CRE and to identify risk factors of such conditions.MethodsThis study was conducted among a cohort of hospitalized adult patients colonized by CRE at any sites from June 1, 2015 to December 31, 2018. The patients had been prospectively identified by the Infection Control (IC) Division of a Thai tertiary-care hospital. According to the hospital’s IC protocol, patients with CRE colonization/infections were isolated and underwent CRE cultured at the colonized/infected sites every week until the cultures have turned negative for 2 consecutive times. Prolonged colonization was defined as having CRE colonization more than 30 days.ResultsOf the 125 patients identified, 25 were excluded due to death, being transferred, or discharged within 48 hours of CRE colonization detected. The final cohort included 100 patients, the median age was 74 years, 48% were male, the most common colonized site was rectum (37%) and 20 patients (20%) developed subsequent CRE-associated infections. The median time from colonization to infection was 13 days and the most common site of infection was bloodstream (45%). Independent factors associated with subsequent CRE-associated infections were the number of colonization sites [adjusted odds ratio (aOR) 7.98, P < 0.001)], central line insertion during admission (aOR 7.97, P = 0.009) and receipt of vancomycin during admission (aOR 24.77, P = 0.02). Prolonged colonization was observed in 13 of 77 evaluable patients (17%). There were trends toward significance that the length of hospital stay and duration of antibiotic prior to colonization were associated with prolonged colonization (P < 0.10).ConclusionThe findings suggest high rates of subsequent CRE-associated infections and prolonged colonization among the study population. Patients with risk factors for subsequent infections should be closely monitored and empirically-treated with antibiotics active against CRE while those with risk factors for prolonged colonization should receive continued surveillance and isolation to prevent CRE transmission.Disclosures All authors: No reported disclosures.

Environmental Prevalence of Carbapenem Resistance Enterobacteriaceae (CRE) in a Tropical Ecosystem in India: Human Health Perspectives and Future Directives.

In the past few decades, infectious diseases have become increasingly challenging to treat, which is explained by the growing number of antibiotic-resistant bacteria. Notably, carbapenem-resistant Enterobacteriaceae (CRE) infections at global level attribute a vast, dangerous clinical threat. In most cases, there are enormous difficulties for CRE infection except a few last resort toxic drugs such as tigecycline and colistin (polymyxin E). Due to this, CRE has now been categorized as one among the three most dangerous multidrug resistance (MDR) pathogens by the US Centres for Disease Control and Prevention (CDC). Considering this, the study of the frequency of CRE infections and the characterization of CRE is an important area of research in clinical settings. However, MDR bacteria are not only present in hospitals but are spreading more and more into the environment, thereby increasing the risk of infection with resistant bacteria outside the hospital. In this context, developing countries are a global concern where environmental regulations are often insufficient. It seems likely that overcrowding, poor sanitation, socioeconomic status, and limited infrastructures contribute to the rapid spread of MDR bacteria, becoming their reservoirs in the environment. Thus, in this review, we present the occurrence of CRE and their resistance determinants in different environmental compartments in India.

Antimicrobial Resistance Pattern of Extensively Drug Resistant Carbapenemase Producing Enterobacteriaceae

Carbapenems, often agents of last resort for multidrug resistant bacterial infections are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Production of carbapenemases remain the most clinically important mechanism of carbapenem resistance in Enterobacteriaceae. The objective of this study was to determine the antibiogram pattern of carbapenemase producing Enterobacteriaceae. A cross sectional study was conducted at department of Microbiology and Immunology, BSMMU from September 2018 to August 2019. A total of 145 CRE isolates from different clinical samples were studied.Antimicrobial susceptibility was examinedby disk diffusion method and MIC of colistin by broth microdilution method. Resistant carbapenemase genes NDM and OXA-48 were identified by polymerase chain reaction. Out of 145 CRE isolates, 104 were NDM, 73 were OXA-48and 34 isolates were both NDM and OXA-48 co-producers. All the NDM and OXA-48 carbapenemase producing isolates were 100% resistant to meropenem, imipenem, ertapenem, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, amoxicillin + clavulanic acid and piperacillin + tazobactam. Resistance rates of reserved antimicrobials to treat CRE isolates were also alarming. Thirty seven percent, 9.6% and 5.5 % of OXA-48 carbapenemase producers and 26.0%, 10.6% and 2.9% of NDM carbapenemase producers were resistant to colistin, polymyxin B and tigecycline respectively.Among the carbapenemase producing isolates, 16.6% (24) were multidrug resistant (MDR), 82.1% (119) were extensively drug resistant (XDR) and 1.3% (2) isolates were pan drug resistantwhich highlights the emerging therapeutic challenge for these superbugs.&#x0D; Bangladesh J Med Microbiol 2019; 13 (2): 7-10

Carbapenemase-producing Enterobacteriaceae (CPE) isolated from pigs in China

Background The increasing prevalence of CPE is a global concern in public health. CPE were found to be present in livestock. Food animals act as a reservoir for NDM-producing bacteria. However, there is limited information about CPE in food animals. Here we screen the carbapenemase-producing bacteria in pig samples. Objective To investigate the prevalence of carbapenem resistance in swine from China. Methods A total of 138 rectal swabs from pigs imported from China were collected in Hong Kong between June 2017 and Oct 2018. Bacterial identification was conducted by MALDI-TOF for all isolates. Carba-NP test and disc diffusion method were performed to detect carbapenemase and determine the antibiotic susceptibility. Identification of carbapenemase gene and replicon type of plasmid, and further characterization of isolates were performed through PCR and next-generation sequencing respectively. Results Twenty-one CPE isolates including Escherichia coli (n=20) and Enterobacter cloacae (n=1) were isolated from 20 pigs, which were resistant to carbapenem (meropenem, ertapenem and imipenem). The prevalence rate of carbapenemase producers was 14 % (20/138). All isolates were positive in carba-NP test and harboured carbapenemase gene bla NDM. Two-third of IncX3 (14/21) plasmid appeared in bla NDM-producing isolates. Different resistance patterns were discovered among NDM-carrying isolates, but all of them were susceptible to fosfomycin and azithromycin. Conclusion Our data show that the prevalence of carbapenem-resistance Enterobacteriaceae among swine in China during 2017 to 2018 . It is also observed that NDM carbapenemases is still circulating in pigs over times.

Detection of extended-spectrum β-lactam, AmpC and carbapenem resistance in Enterobacteriaceae in beef cattle in Great Britain in 2015.

This study investigated the occurrence and genetic diversity of Enterobacteriaceae with extended-spectrum β-lactamase (ESBL)-, AmpC- and carbapenemase-mediated resistance in British beef cattle, and related risk factors. Faecal samples (n=776) were obtained from farms in England and Wales (n=20) and Scotland (n=20) in 2015. Isolates from selective agars were identified by MALDI ToF mass spectrometry. Selected isolates were characterized by multiplex PCR (blaCTX -M, blaOXA , blaSHV and blaTEM genes), whole-genome sequencing (WGS), minimum inhibitory concentrations and pulsed-field gel electrophoresis. None of the faecal samples yielded carbapenem-resistant Escherichia coli. Ten (25%) of the farms tested positive for ESBL-producing CTX-M Enterobacteriaceae, 15 (37·5%) of the farms were positive for AmpC phenotype E.coli and none were positive for carbapenem-resistant E.coli. WGS showed a total of 30 different resistance genes associated with E.coli, Citrobacter and Serratia from ESBL agars, and colocation of resistance genes with blaCTX -M1 . Buying bulls and bringing in fattening cattle from another farm were identified as significant risk factors for positive samples harbouring CTX-M Enterobacteriaceae or AmpC phenotype E.coli respectively. Beef cattle on a proportion of farms in GB carry ESBL-producing Enterobacteriaceae. Factors, such as operating as a closed herd, may have an important role in reducing introduction and transmission of resistant Enterobacteriaceae. The results indicate management factors may play an important role in impacting ESBL prevalence. In particular, further study would be valuable to understand the impact of maintaining a closed herd on reducing the introduction of resistant Enterobacteriaceae. This is the first study showing the presence of ESBL-producing Enterobacteriaceae in British beef cattle.

Meropenem/Vaborbactam: A Review in Complicated Urinary Tract Infections.

The global threat of the spread of carbapenem resistance in Enterobacteriaceae has led to the search for new antibacterials. Intravenous meropenem/vaborbactam (Vabomere™) is the first carbapenem/β-lactamase inhibitor combination approved in the USA for use in patients with complicated urinary tract infections (cUTIs), including pyelonephritis. Vaborbactam is a potent inhibitor of class A serine carbapenemases, which, when combined with the antibacterial meropenem, restores the activity of meropenem against β-lactamase producing Enterobacteriaceae, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae. Meropenem/vaborbactam demonstrated excellent in vitro activity against Gram-negative clinical isolates, including KPC- and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In the phase 3, noninferiority TANGO I trial in patients with cUTIs, intravenous meropenem/vaborbactam was noninferior to intravenous piperacillin/tazobactam for overall success (composite of clinical cure and microbial eradication; FDA primary endpoint) and microbial eradication (EMA primary endpoint). In subsequent superiority testing, meropenem/vaborbactam was superior to piperacillin/tazobactam for overall success. Meropenem/vaborbactam was generally well tolerated, with a tolerability profile generally similar to that of piperacillin/tazobactam. TANGO I did not assess the efficacy of meropenem/vaborbactam for the treatment of infections caused by carbapenem-resistant Enterobacteriaceae and meropenem/vaborbactam is currently not indicated for these patients. Available evidence indicates that meropenem/vaborbactam is a useful treatment option for patients with cUTIs.

Integrons associated with carbapenem resistance in Enterobacteriaceae isolated from clinical specimens at a tertiary academic hospital in Pretoria

Integrons associated with carbapenem resistance in Enterobacteriaceae isolated from clinical specimens at a tertiary academic hospital in Pretoria

Phenotypic and genotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae from blood culture specimens: A study from North India.

BACKGROUND:Emergence of carbapenem resistance among Enterobacteriaceae in different geographical regions is of great concern as these bacteria are easily transmissible among patients. Carbapenem-resistance in Enterobacteriaceae is due to production of carbapenemases of various classes and hyper production of the ESBLs (Extended spectrum beta lactamases) and Amp C beta lactamases with reduced cell wall permeability mechanisms. Phenotypic detection and differentiation is important for proper infection control and appropriate patient management. This study was done to know the prescence of various beta lactamases and carbapenemases with other mechanisms of resistance in Klebsiella pneumoniae isolates.MATERIALS AND METHODS:50 non-duplicate carbapenem resistant isolates of Klebsiella pneumoniae from blood culture specimens were included and various mechanisms of resistance were studied based on phenotypic and genotypic methods.RESULTS:Out of 50 isolates, 39 (78%) of K. pneumoniae isolates were Extended Spectrum Beta Lactamase (ESBL) producers based on CLSI guidelines. All 50 showed positive Modified Hodge Test (MHT) and 32 showed Metallo Beta Lactamase (MBL) by Combined Disc Test (CDT). Four isolates showed AmpC production with porin loss. None of the isolates showed Class A KPC production by CDT. In our study all the 10 isolates evaluated by genotypic technique produced CTX-M group 1 enzyme by multiplex PCR. Seven out of 10 strains which showed positive MBL results were positive for NDM.CONCLUSIONS:Carbapenems are often considered last resort antibiotics in the treatment of infections due to multidrug-resistant organisms. It is therefore mandatory to maintain the clinical efficacy of carbapenems by early detection of various enzymes. For routine clinical laboratories both phenotypic and genotypic tests need to be followed to detect various mechanisms of carbapenem resistance and this is of epidemiological relevance also.

New Delhi Metallo-Beta-Lactamase-Producing Enterobacteriaceae in South Korea Between 2010 and 2015.

This study was carried out to investigate the epidemiological time-course of New Delhi metallo-beta-lactamase- (NDM-) mediated carbapenem resistance in Enterobacteriaceae in South Korea. A total of 146 non-duplicate NDM-producing Enterobacteriaceae recovered between 2010 and 2015 were voluntarily collected from 33 general hospitals and confirmed by PCR. The species were identified by sequences of the 16S rDNA. Antimicrobial susceptibility was determined either by the disk diffusion method or by broth microdilution, and the carbapenem MICs were determined by agar dilution. Then, multilocus sequence typing and PCR-based replicon typing was carried out. Co-carried genes for drug resistance were identified by PCR and sequencing. The entire genomes of eight random selected NDM producers were sequenced. A total of 69 Klebsiella pneumoniae of 12 sequence types (STs), 34 Escherichia coli of 15 STs, 28 Enterobacter spp. (including one Enterobacter aerogenes), nine Citrobacter freundii, four Raoultella spp., and two Klebsiella oxytoca isolates produced either NDM-1 (n = 126), NDM-5 (n = 18), or NDM-7 (n = 2). The isolates co-produced CTX-M-type ESBL (52.1%), AmpCs (27.4%), additional carbapenemases (7.1%), and/or 16S rRNA methyltransferases (4.8%), resulting in multidrug-resistance (47.9%) or extensively drug-resistance (52.1%). Among plasmids harboring blaNDM, IncX3 was predominant (77.4%), followed by the IncFII type (5.8%). Genome analysis revealed inter-species and inter-strain horizontal gene transfer of the plasmid. Both clonal dissemination and plasmid transfer contributed to the wide dissemination of NDM producers in South Korea.

Epidemiology and treatment of antimicrobialresistant gram-negative bacteria in Korea

Antimicrobial resistance is becoming one of the greatest challenges to public health worldwide. Infections by antimicrobial-resistant organisms could result in the failure of treatment, increased medical costs, prolonged hospital stays, and an increased socioeconomic burden. Antimicrobial usage in Korea remains heavy, even after much effort to reduce their use. According to the Korean antimicrobial resistance surveillance system, the resistance rates of many bacteria are increasing. The resistance rate of Acinetobacter baumannii to imipenem in Korea increased to 85% in 2015, representing a major public threat. The reports of increased carbapenem resistance in Enterobacteriaceae are worrisome. More importantly, some carbapenem-resistant Enterobacteriaceae may result from the production of carbapenemases, which break down carbapenems. There are relatively few treatment options for extensively drug-resistant A. baumannii and carbapenem-resistant Enterobacteriaceae. Most reports are retrospective observational studies. Because there are little published data from randomized controlled trials, more data assessing antimicrobial treatment for extensively drug-resistant A. baumannii and carbapenem-resistant Enterobacteriaceae are needed to make treatment recommendations.

Comparison of three phenotypic methods for the screening of carbapenem resistance among clinical isolates of Enterobacteriaceae

Background: The global use, misuse, and abuse of broad-spectrum antibiotics coupled with failure of development of newer effective antibiotics have led to the rapid spread of carbapenemase producing Gram-negative Enterobacteriaceae. The lack of capacity for effective diagnosis results in increased morbidity, prolonged hospitalization, suboptimal treatment leading to treatment failure, and increased healthcare cost. Aims/objectives: We set out to determine the best method(s) for the phenotypic screening of carbapenem resistance among the species of Enterobacteriaceae at University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: We screened all patients admitted into various wards/units of UMTH over a 6-month period to isolate Enterobacteriaceae. We used an interviewer-administered questionnaire to obtain some basic information from the patients. We confirmed the species of Enterobacteriaceae using Microbact Gram-negative 24E test kit. All confirmed isolates were screened for carbapenem resistance with Meropenem and Ertapenem antibiotic discs (10 μg, Oxoid, UK) according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Minimum inhibitory concentration (MIC) using Etest of Imipenem (Biomeriux) was also determined based on CLSI recommendations. Modified Hodge test method was considered as a gold standard for confirmatory test. The three methods were compared with the gold standard. Results: We isolated 225 Enterobacteriaceae from 225 patients. Klebsiella pneumoniae had the highest proportion of 73 (32.4%). The sensitivity of the different methods in increasing order was 95.7% for Meropenem disk (10 μg), 100% for Ertapenem disk (10 μg), and 100% for Imipenem MIC. Conclusion: In view of cost and availability, the Ertapenem disc (10 μg) method can be used for the screening of carbapenem-resistant Enterobacteriaceae. For the routine screening of carbapenem resistance Enterobacteriaceae in our clinical laboratories, the Ertapenem disc (10 μg) method is recommended.

Direct determination of carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa from positive blood cultures using laser scattering technology

Delays in appropriate antimicrobial treatment contribute to increased mortality of septic patients. We aimed to develop a methodology for detection of carbapenem resistance in Gram-negative bacteria directly from positive blood cultures (BCs). Initially, meropenem-resistant Enterobacteriaceae (n = 13) and Pseudomonas aeruginosa (n = 32) isolates as well as the same numbers of meropenem-susceptible isolates were used to establish the detection of carbapenem resistance from agar cultures. Growth-based phenotypic detection of meropenem resistance was performed by a laser scattering (LS) method using a BacterioScan™216R instrument. A subset of the strain collection consisting of meropenem-susceptible and -resistant isolates (each comprising seven P. aeruginosa and three Klebsiella pneumoniae) was used for determination of carbapenem resistance directly from positive BCs. Lysis/centrifugation and filtration/dilution methods were investigated for processing of positive BCs. Four different statistical approaches to discriminate between susceptible and resistant bacteria in real-time were applied and were compared regarding their sensitivity and specificity. After 3 h and 4 h of incubation, respectively, detection of carbapenem resistance in Enterobacteriaceae (sensitivity, 100%; specificity, 100%) and P. aeruginosa (sensitivity, 100%; specificity, ≥90%) agar cultures was attainable. Detection of carbapenem resistance directly from positive BCs was achievable with 100% sensitivity and 100% specificity after 4 h and 5 h, respectively, applying lysis/centrifugation and filtration/dilution methods. In conclusion, LS technology combined with lysis/centrifugation and appropriate statistical real-time analyses represents a promising option for rapid detection of carbapenem resistance in Gram-negative rods directly from positive BCs.

Hospital Acquired Infections by Carbapenem Resistant Enterobacteriacea

CRE) infections have become an increasing concern for healthcare services worldwide. Community and hospital-acquired infections caused by these bacteria have been associated with significant morbidity and mortality with limited treatment options. Rapid and accurate detection of carbapenem resistance in these bacteria is important for infection control. Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae (CRE) species and determine their antimicrobial susceptibility profile using the Vitek 2 system and detect the presence of carbapenemases genes using Multiplex PCR. Methodology: Various clinical samples were collected from 469 patients admitted in Sohag university hospitals in the period between April 2016 and August 2017, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48. Results: The prevalence of carbapenem resistant Enterobacteriaceae (CRE) species was 19.9%, Klebsiella pneumoniae was the most common species (51.4%), Escherichia Coli (28.6%), Enterobacter aerogenes(8.6%), Acinetobacter baumannii (5.7%), Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy, 25.7 % of CRE strains were isolated from the internal ICU and 20 % from chest department and mostly isolated from urine(40%) and from endotracheal tubes swabs(28.6%), 77.1% of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive. Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicates that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures, we recommend routine testing to determine carbapenem resistance in Enterobacteriaceae in health facilities in Egypt. Keywords: Carbapenem, Enterobacteriacea, Vitek 2, Multiplex PCR Corresponding author: Tamer Mohamed Mahmoud, Department of Medical Microbiology and Immunology, Sohag University. E-mail: tamermmm2000@yahoo.com

Descrição de casos de Enterobactérias Produtoras de Carbapenemases subtipos Oxa-48 e NDM em hospital público de Porto Alegre

Justificativa: A multirresistência bacteriana vem preocupando gestores e profissionais de saúde em esfera global. Neste contexto, a resistência aos carbapenêmicos em enterobactérias é particularmente preocupante em função de sua alta mortalidade (de 40 a 50% em 30 dias) e pelas reduzidas opções de tratamento. Entre as carbapenemases, os subtipos KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi Metallobetalactamase) e OXA (Oxa-carbapenemase) são encontrados no estado. Objetivo: descrever os casos de enterobatérias produtoras de carbapenemase (EPC) subtipos OXA e NDM em um hospital público de Porto Alegre. Método: Trata-se de pesquisa transversal, utilizando o banco de dados da Comissão de Controle de Infecção Hospitalar do hospital em estudo. A coleta de dados ocorreu após aprovação do Comitê de Ética em Pesquisa no mês de abril de 2015. A amostra englobou os casos confirmados de EPC subtipos OXA e NDM de janeiro a dezembro de 2013. Resultados: Foram identificados 34 casos de EPC, sendo 22 casos confirmados do subtipo OXA-48 e 12 casos do subtipo NDM. Entre os pacientes portadores do subtipo OXA-48, os homens totalizaram 77,3% e a colonização superou em muito a infecção 81,2%; a mortalidade atingiu 54,5% dos casos, sendo que o microrganismo mais prevalente foi a Klebsiella pneumoniae (45,5%). Os homens somaram 58,4% dos casos de NDM, com predominância de colonizações 83,3% em isolados de Enterobacter cloacae, cuja mortalidade contabilizou 58,3%. Conclusões: A elevada mortalidade e a prevalência de colonizações foram relevantes nesta pesquisa. Portanto, a detecção precoce destes mecanismos de resistência pode contribuir para conter sua disseminação. &#x0D; Descritores: Resistência microbiana a medicamentos; Controle de infecções; Enterobacteriaceae

Emergence and spread of antibiotic resistance in West Africa: contributing factors and threat assessment.

The emergence and spread of antibiotic resistance present a major public health issue in both developed (DC) and less developed countries (LDC). Worldwide, its main cause is the uncontrolled and unjustified use of antibiotics. In countries with limited resources, such as West African nations, other features, more specifically socioeconomic and behavioral factors, contribute to exacerbate this problem. The objective of this review is to give an update of the common and specific factors involved in the amplification of antibiotic resistance phenomena in LCD, particularly in West African countries. In particular, some frequent societal behaviors (such as self-medication), inadequate healthcare infrastructure (insufficiently trained prescribers and inadequate diagnostic tools), and an uncontrolled drug sector (antibiotics sold over-the-counter, improperly stored, counterfeit, and/or expired) all strongly promote the emergence of antibiotic resistance. This risk is particularly worrisome for enterobacteriaceae producing extended spectrum beta-lactamases (10 to 100% of colonizations and 30 to 50% of infections). A similar trend has been observed for carbapenem resistance in enterobacteriaceae with rates ranging from 10 to 30% and for methicillin resistance in Staphylococcus aureus, which now exceeds 30%. These troubling observations call for effective health policies in these regions. These intervention strategies must be integrated and simultaneously target policy makers, prescribers, and users.

Predictors for the Acquisition of Carbapenem Resistance Enterobacteriaceae (CRE) from a Teaching Hospital of Northeastern Nigeria

Predictors for the Acquisition of Carbapenem Resistance Enterobacteriaceae (CRE) from a Teaching Hospital of Northeastern Nigeria

The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace.

Carbapenem-resistant Enterobacteriaceae (CRE) are a serious public health threat. Infections due to these organisms are associated with significant morbidity and mortality. Mechanisms of drug resistance in gram-negative bacteria (GNB) are numerous; β-lactamase genes carried on mobile genetic elements are a key mechanism for the rapid spread of antibiotic-resistant GNB worldwide. Transmissible carbapenem-resistance in Enterobacteriaceae has been recognized for the last 2 decades, but global dissemination of carbapenemase-producing Enterobacteriaceae (CPE) is a more recent problem that, once initiated, has been occurring at an alarming pace. In this article, we discuss the evolution of CRE, with a focus on the epidemiology of the CPE pandemic; review risk factors for colonization and infection with the most common transmissible CPE worldwide, Klebsiella pneumoniae carbapenemase-producing K. pneumoniae; and present strategies used to halt the striking spread of these deadly pathogens.

Outbreak of carbapenem-resistant Providencia rettgeri in a tertiary hospital

The emergence of resistance to multiple antimicrobial agents in pathogenic bacteria is a significant public health threat, as there are limited effective antimicrobial agents for infections caused by multidrug-resistant (MDR) bacteria. Several MDR bacteria are now frequently detected. Carbapenem resistance in Enterobacteriaceae is often plasmid mediated, necessitating stringent infection control practices. We describe an outbreak of carbapenem-resistant Providencia rettgeri involving 4 patients admitted to intensive care and high-care units at a tertiary hospital. Clinical and demographic characteristics of 4 patients with carbapenem-resistant P. rettgeri were documented. All P. rettgeri isolated in these cases had a carbapenem-resistant antibiogram, with resistance to imipenem, ertapenem and meropenem. These cases could be epidemiologically linked. A multiprong approach, simultaneously targeting antibiotic stewardship, universal precautions and appropriate transmission-based precaution practices, is integral to prevention and control of nosocomial infections.

Carbapenem Resistance in Enterobacteriaceae: Trends from Active, Population-based Surveillance Using Automated Testing Instrument Queries in Hennepin and Ramsey Counties, Minnesota, 2013–2015

Carbapenem Resistance in Enterobacteriaceae: Trends from Active, Population-based Surveillance Using Automated Testing Instrument Queries in Hennepin and Ramsey Counties, Minnesota, 2013–2015