Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Abstract

Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections, however carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6–10.8%. The presence of CRE in the community poses an urgent public health threat.

Enterobacter cloacae Complex Sequence Type 171 Isolates Expressing KPC-4 Carbapenemase Recovered from Canine Patients in Ohio

“…T he plasmid-mediated Klebsiella pneumoniae carbapenemase (KPC) emerged in the late 1990s and has become the predominant carbapenemase in clinical carbapenemresistant Enterobacteriaceae (CRE) isolates; these are primarily associated with the clonal dissemination of strains of K. pneumoniae, Enterobacter spp., and Escherichia coli (1,2). While health care-associated infections (HAI) comprise the majority of all cases involving CRE, community-associated infections (CAI) comprise up to 10.8% of CRE cases in the United States (3).…”

Antipathy against SDD is justified: Yes

“…The spread of carbapenemase-producing gram-negative bacteria (GNB) in the community mimics the ESBL-PE pandemic [8]. A systematic review showed a rate of 5-10% in the USA, and up to 29.5% in one study from Taiwan.…”

Iterative Fecal Microbiota Transplantations for Eradicating Digestive Colonization With Carbapenemase-Producing Enterobacteriaceae: Is It Worth It?

“…2 In addition, a recent review of the literature demonstrated that according to US-based studies, the percentage of CPE isolates that could be associated with the community ranged from 5.6% to 10.8%. 3 We have recently demonstrated the less effective effect of fecal microbiota transplantation (FMT) on CPE compared to vancomycin-resistant Enterococci (VRE) fecal carriage. 4 Those results are consistent with another recent study 5 conducted in 6 patients colonized with CPE and showing an eradication of the colonization in only 2 of these 6 patients.…”