Community-Onset Bloodstream and Other Infections, Caused by Carbapenemase-Producing Enterobacteriaceae: Epidemiological, Microbiological, and Clinical Features

Abstract

Background. Because most infections caused by carbapenemase-producing Enterobacteriaceae (CPE) begin during hospitalization, there are limited data about community-onset (CO) infections caused by CPE. Our aim is to describe the frequency of CO infections caused by CPE as well as the clinical features of CO bloodstream infections (CO-BSIs).Methods. This study includes retrospective case series of CO infections caused by CPE in a tertiary hospital from January 2010 to July 2014. Any clinical sample with a positive culture for CPE that had been ordered by primary care doctors or by doctors at the emergency room (ER) were classified as CO. Epidemiological and microbiological features of CO cases were assessed as were clinical features of CO-BSIs.Results. Of 780 clinical samples with CPE, 180 were requested at the ER or by primary care doctors (22.9%), 150 of which were produced by Klebsiella pneumoniae (83.3%). The blaOXA−48 gene was detected in 149 isolates (82.8%) followed by the blaVIM gene, 29 (16.1%). Sixty-one patients (33.9%) had a prior history of CPE infection/colonization. Thirty-four of the 119 (28.6%) patients without prior history of CPE infection/colonization did not fulfill Friedman criteria for healthcare-associated infections (HAIs). Considering previous hospitalization of up to 12 months as a criterion for defining HAI, only 16 (13.4%) cases were identified as community-acquired infections. The most frequent positive sample was urine (133 of 180; 73.9%). Twenty-one (11.7%) patients had a BSI, 9 of them secondary to urinary tract infections (42.9%). Thirty-day crude mortality among patients with BSI was 23.8% (5 of 21).Conclusions. Community-onset infections caused by CPE are an important subgroup of all CPE infections. The urinary tract is the main source. Bloodstream infections accounted for more than 10% of the cases.

Evolving beta-lactamase epidemiology in Enterobacteriaceae from Italian nationwide surveillance, October 2013: KPC-carbapenemase spreading among outpatients

“…It might herald a possible dissemination in the community like the one previously witnessed with CTX-M-producing E. coli [ 40 ]. Indeed, recent reports from the US and Spain have described the emergence of CPE infections also in the community, underscoring this possibility [ 41 , 42 ]. Such a scenario should be avoided, and suitable infection control measures should be enforced to address this phenomenon in settings of high CRE endemicity like Italy and some other European countries [ 37 ].…”

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

“…However, the CA rate could have been overestimated due to possible long-term persistence as stated above (up to 740 days) while using 1 year from last hospitalization in the definition of CA. A scoping review found that the percentage of either CA or community-onset carbapenemase-resistant Enterobacterales ranged from 0.04% to 29.5% [17], while a study reported the rate of community-onset infections caused by CPE as 22.9% [18]. Moreover, 69.4% of the 62 CA cases in the present study were NDM/OXA-48 producers.…”

Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistantEnterobacteriaceae?

“…The emergence of multi-drug resistant microorganisms has become one of the most important hazards that health care is facing worldwide. Development of such resistance can be attributed to many risk factors including previous ICU admission, presence of a central venous catheter especially in hemato-oncology patients who are receiving chemotherapy, presence of an indwelling catheter insertion, prolonged use of antibiotics, prolonged hospital stay, hospitalization in an area endemic for multidrug resistance (MDR) and a history of previous colonization or infection with these microorganisms[ 16 , 17 ]. Resistance to β-lactams in Enterobacteriaceae is primarily attributed to the production of B-lactamase enzymes with subsequent antibiotic hydrolysis and to a lesser extent by alteration of efflux pump or porins expression[ 18 ].…”