Factors associated to prevalence and treatment of carbapenem-resistant Enterobacteriaceae infections: a seven years retrospective study in three tertiary care hospitals

Abstract

BackgroundThe increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a difficult problem in the current clinical anti-infective treatment. We performed a retrospective analysis of prevalence and treatment for CRE infections patients.MethodsThis study was conducted in three tertiary care hospitals from January 1, 2010 to December 30, 2016. Baseline data, treatment, and outcomes were collected in patients with ventilator-associated bacterial pneumonia (VABP), bacteremia, complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), superficial wound infection (SWI), biliary tract infection (BTI), deep wound infection (DWI) and sterile body fluids infection (SBFI) due to CRE.ResultsOne hundred twenty-four cases of CRE infection were identified: 31 VABP, 22 bacteremia, 18 cUTI/AP, 16 HABP, 16 SWI, 9 BTI, 7 DWI and 5 SBFI. The patient population had significant immunocompromised (33 of 124, 26.6%) and severe sepsis (43 of 124, 34.7%). The most common CRE pathogens were Klebsiella pneumoniae (84 of 124, 67.7%) and Enterobacter cloacae (24 of 124, 19.4%). And the production of IMP-type carbapenemase was the main antibiotic resistance mechanism. The majority of patients to take monotherapy for empiric therapy and dual therapy for direct treatment. Outcomes were universally poor (28-day mortality was 22.6%, 28 of 124) across all sites of infection.ConclusionsWe identified a large number of cases of CRE infection in 7 years from different parts, most of these pathogens have been confirmed to produce IMP-type carbapenemases. The retrospective analysis of cases of such bacterial infections will help to control future infections of these pathogens. Despite the high mortality rate, we still found that the selection of quinolone antibiotics can be effective in the treatment of CRE producing IMP type enzymes.

Appropriateness of empiric antimicrobial therapy with imipenem/colistin in severe septic patients: observational cohort study

“…2 b). Vasopressors requirement was significantly superior in the inappropriate EAMT group with a mean duration of 8 days [ 6 – 14 ] versus 5 days [ 2 – 8 ] in the appropriate EAMT group, p = 0.026. There were no differences in ventilator days and in ICU stays between appropriate versus inappropriate EAMT (15 ± 5.9 vs 18 ± 7 days, p = 0.5 and 22 ± 12 vs 29 ± 15 days, p = 0.37 respectively).…”

“…Vasopressors requirement was significantly superior in the inappropriate EAMT group with a mean duration of 8 days [ 6 – 14 ] versus 5 days [ 2 – 8 ] in the appropriate EAMT group, p = 0.026.…”

“…Worldwide as in Tunisia, three ‘’leaders’’ of MDR-GNB were often reported: Enterobacteria (mainly the extended-spectrum beta lactamase (ESBL) secreting and emergence of carbapenemase-producing strains) , Acinetobacter spp. and Pseudomonas aeruginosa [ 4 , 8 – 13 ].…”

Inoculum size effects in blaIMP-6 and plasmid-mediated quinolone resistance gene-positive Enterobacteriaceae in Japan

“…On the other hand, the reported susceptibility to meropenem and imipenem among bla IMP-6 positive E. coli was approximately 70% and 100% (4). Pang et al have reported that most pathogens have been confirmed to produce IMP-type carbapenemases, and some cases have been successfully treated with quinolone monotherapy as a definitive therapy based on drug susceptibility tests (7). However, in the present study the isolates did not show resistance to levofloxacin, amikacin, and carbapenems based on the CLSI definition, and the MICs of some isolates turned to be high enough to be resistant to these drugs especially meropenem (the MIC for all isolates was ≥ 16 μg/mL) at 100-fold the standard inoculum size.…”

“…On the other hand, fortunately, many of the bla IMP-6 positive CPEs are susceptible to levofloxacin and amikacin (6). Thus, based on the results of drug susceptibility tests, some infectious cases caused by IMP-type carbapenemase producing Enterobacteriaceae have been treated with quinolone monotherapy (7).…”