Carbapenem-Resistant <i>Enterobacter</i><i>cloacae</i> in Patients from the US Veterans Health Administration, 2006–2015

Wilson, Brigid; Chakhtoura, Nadim G. El; Patel, Sachin; Saade, Elie; Donskey, Curtis J.; Bonomo, Robert A.; Pérez, Federico

doi:10.3201/eid2305.162034

Cited by 55 publications

(47 citation statements)

References 9 publications

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“…Both pathogens have seen rapid increases in Carb-NS rates in the past few years [15, 16]. In the United States, rates of carbapenem-resistant K. pneumoniae increased from 0.1% in 2002 to 4.5% in 2010 [15].…”

Section: Discussionmentioning

confidence: 99%

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Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

McCann

Srinivasan

DeRyke

et al. 2018

Open Forum Infectious Diseases

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BackgroundInfections caused by Gram-negative pathogens resistant to carbapenems have limited treatment options and are associated with increased morbidity and mortality. We evaluated the rates, infection sources, and pathogen types associated with carbapenem-nonsusceptible (Carb-NS) Gram-negative isolates in intensive care unit (ICU) and non-ICU settings in a large US hospital database.MethodsWe conducted a retrospective cross-sectional analysis of carbapenem susceptibility of all nonduplicate isolates of Gram-negative pathogens collected from January 1, 2017, to December 31, 2017, at 358 US hospitals in the BD Insights Research Database. Carb-NS isolates included all pathogens reported at the institutional level as intermediate or resistant.ResultsOf 312 075 nonduplicate Gram-negative isolates, 10 698 (3.4%) were Carb-NS. Respiratory samples were the most frequent source of Carb-NS isolates (35.2%); skin/wound accounted for 23.6%. Pseudomonas aeruginosa was the most common Carb-NS pathogen (58.5% of isolates), and about 30% were Enterobacteriaceae. The highest rates of Carb-NS were found in Acinetobacter spp. (35.6%) and P. aeruginosa (14.6%). The rate of Carb-NS was significantly higher in ICU (5.4%) vs non-ICU settings (2.7%; P < .0001 in univariate analysis). This difference remained significant in multivariable analysis after adjusting for infection and hospital characteristics (odds ratio, 1.35; 95% confidence interval, 1.17–1.56; P < .0001).ConclusionsInfections caused by Carb-NS isolates pose a significant clinical problem across different sources of infection, species of pathogen, and hospital settings. Widespread infection prevention and antimicrobial stewardship initiatives, in combination with new treatment options, may be required to reduce the burden of carbapenem resistance in health care settings.

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Section: Discussionmentioning

confidence: 99%

“…Although less common, E. cloacae had the highest Carb-NS rate among Enterobacteriaceae in our analysis. Recent studies have suggested that subsequent to the rapid increase that occurred in carbapenem-resistant K. pneumoniae , a “second epidemic” of carbapenem-resistant E. cloacae may be occurring [16]. …”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

McCann

Srinivasan

DeRyke

et al. 2018

Open Forum Infectious Diseases

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“…the United States, with almost half of CRE infections consisting of carbapenemase producers (CP-CRE) (1)(2)(3). Patients hospitalized in the intensive care unit (ICU) setting are at particularly high risk of newly acquiring CRE during their hospital stay because the multiple preexisting medical conditions, compromised immune systems, lengthy unit stays, and significant rates of device and antibiotic utilization establish an ideal milieu for antibiotic resistance (4,5).…”

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confidence: 99%

The Likelihood of Developing a Carbapenem-Resistant Enterobacteriaceae Infection during a Hospital Stay

Kazmi

Bergman

Goodman

et al. 2019

Antimicrob Agents Chemother

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Of 1,455 unique patients in U.S. intensive care units (ICUs), 4% were rectally colonized with CRE on admission. A total of 297 patients were initially negative for carbapenem-resistant Enterobacteriaceae (CRE) and remained in the ICU long enough to contribute additional swabs; 22% of these patients had a subsequent CRE-positive swab, with a median time to CRE colonization of 13 days (interquartile range, 7 to 21 days). Patients colonized with carbapenemase-producing CRE were more likely than those colonized with non-carbapenemase-producing CRE to develop CRE infections during their hospitalizations (36% versus 3%; P Ͻ 0.05).

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“…The recent increase in infections caused by carbapenem-resistant organisms in the United States has been largely driven by the dissemination of plasmid-encoded carbapenemases, which are often carried by members of the Enterobacterales , particularly Klebsiella pneumoniae (6, 7). However, rates of other carbapenem-resistant bacterial species have also increased (8). Among them, carbapenem-non-susceptible Citrobacter spp.…”

Section: Introductionmentioning

confidence: 99%

Clinical and genomic epidemiology of carbapenem-non-susceptibleCitrobacterspp. at a tertiary healthcare center over two decades

Babiker

Evans

Griffith

et al. 2020

Preprint

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22Carbapenem-non-susceptible Citrobacter spp. (CNSC) are increasingly recognized as healthcare-23 associated pathogens. Information regarding their clinical epidemiology, genetic diversity, and 24 mechanisms of carbapenem resistance is lacking. We examined microbiology records of adult 25 patients at the University of Pittsburgh Medical Center (UMPC) Presbyterian Hospital (PUH) from 26 2000-2018 for CNSC, as defined by ertapenem non-susceptibility. Over this timeframe, the 27 proportion of CNSC increased from 4% to 10% (P=0.03), as did carbapenem daily defined 28 doses/1000 patient days (6.52 to 34.5, R 2 =0.831, P<0.001), which correlated with the observed 29 increase in CNSC (lag=0 years, R 2 =0.660). Twenty CNSC isolates from 19 patients at PUH and 30 other UPMC hospitals were available for further analysis, including whole-genome short-read 31 sequencing and additional antimicrobial susceptibility testing. Of the 19 patients, nearly all 32 acquired CNSC in the healthcare setting and over half had polymicrobial cultures containing at 33 least one other organism. Among the 20 CNSC isolates, C. freundii was the predominant species 34 identified (60%). CNSC genomes were compared with genomes of carbapenem-susceptible 35Citrobacter spp. from UPMC, and with other publicly available CNSC genomes. Isolates encoding 36 carbapenemases (blaKPC-2, blaKPC-3, and blaNDM-1) were also long-read sequenced, and their 37 carbapenemase-encoding plasmid sequences were compared with one another and with publicly 38 available sequences. Phylogenetic analysis of 102 UPMC Citrobacter spp. genomes showed that 39 CNSC from our setting did not cluster together. Similarly, a global phylogeny of 64 CNSC 40 genomes showed a diverse population structure. Our findings suggest that both local and global 41 CNSC populations are genetically diverse, and that CNSC harbor carbapenemase-encoding 42 plasmids found in other Enterobacterales. 43 isolated from a specimen collected within 72 hours following hospital admission; isolates collected 91 after 72 hours were considered healthcare-associated (22). Clinical characteristics and outcomes 92 of patients with CNSC isolates that underwent further characterization were collected through 93 retrospective chart review. The primary clinical outcome was in-hospital mortality and/or transfer 94 to hospice. 95 96 CNSC isolate characterization 97 Initial species assignment was performed using standard clinical microbiology laboratory 98 methods, and was confirmed or modified after whole-genome sequencing. Carbapenem non-99 susceptibility was initially determined by standard clinical microbiology laboratory methods, and 100 was confirmed by the Kirby-Bauer disk diffusion method as per the 2017 Clinical Laboratory 101 Standards Institute (CLSI) interpretative criteria (20). Susceptibility to additional agents was 102 determined by the broth microdilution method (20). Presence of carbapenemase enzyme activity 103 was assessed by modified carbapenem inactivation (mCIM) test (23). 104 105 Genome sequencing and a...

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Carbapenem-Resistant Enterobactercloacae in Patients from the US Veterans Health Administration, 2006–2015

Cited by 55 publications

References 9 publications

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

The Likelihood of Developing a Carbapenem-Resistant Enterobacteriaceae Infection during a Hospital Stay

Clinical and genomic epidemiology of carbapenem-non-susceptibleCitrobacterspp. at a tertiary healthcare center over two decades

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