Increased Risk for Carbapenem-ResistantEnterobacteriaceaeColonization in Intensive Care Units after Hospitalization in Emergency Department

Salomão, Matias Chiarastelli; Freire, Maristela Pinheiro; Boszczowski, Ícaro; Raymundo, Sueli F; Guedes, Ana Rubia; Levin, Anna S.

doi:10.3201/eid2606.190965

Cited by 34 publications

(34 citation statements)

References 26 publications

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“…The CRE strains mainly distributed in NICU and PICU in our hospital, which might be related to critical underlying diseases, prolonged hospitalization, long-term application of carbapenems and other antimicrobial agents in these departments. 34 In addition, five neonates were identified to carry CRE at birth, which may be attributed to the mother-to-infant transmission, 35 and this remained to be further explored. Enterobacteriaceae such as E. coli and K. pneumoniae are the part of the normal human intestinal flora but often responsible for HAI, 36 and had become the predominant CRE isolates according to the Nationwide Surveillance data of Clinical CRE Strains in China, 37,38 and were also detected in fecal samples in our study, mostly from patients in PICU and NICU.…”

Section: Discussionmentioning

confidence: 99%

Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae from Inpatient Children in a Pediatric Hospital of Shanghai

Pan

Sun

et al. 2020

IDR

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Section: Discussionmentioning

confidence: 99%

Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae from Inpatient Children in a Pediatric Hospital of Shanghai

Pan

Sun

et al. 2020

IDR

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“…Colonization by carbapenem-resistant Enterobacterales (CRE) is an important cause of infection and one of the main sources of CRE dissemination in hospitals and in the community [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The genes determining Enterobacterales antimicrobial resistance have emerged in the past two decades [ 2 , 7 , 9 ] due to selective pressure caused by the wide use of broad-spectrum antibiotics, especially in intensive care units (ICUs) and long-stay hospitals [ 1 , 6 , 8 , 11 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients

Gomides¹,

Fontes²,

Silveira³

et al. 2022

PLoS ONE

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Objective This study aimed to demonstrate the importance of active carbapenem-resistant Enterobacterales (CRE) surveillance and evaluate the prevalence of invasive infections, risk factors, and mortality risk in CRE-colonized patients. Methods Retrospective cohort study analyzing 1,920 patients identified using an active CRE surveillance protocol, admitted to an adult intensive care unit in southeastern Brazil from January 2014 to December 2018. Results There were 297 (15.47%) CRE colonized patients, with one colonized for every six control patients. CRE-colonized patients demonstrated an increased chance of infection (odds ratio [OR] 7.967, p < 0.001). Overall, 20.54% of the colonized patients presented invasive infection (81.96% due to Klebsiella pneumoniae). The colonization and infection ratio demonstrated the important role of the active CRE surveillance protocol. There were identified multiple risk factors for CRE colonization, including long-term mechanical ventilation (OR 1.624, p = 0.019) and previous exposure to aminopenicillins (OR 5.204, p < 0.001), carbapenems (OR 3.703, p = 0.017), cephalosporins (OR 12.036, p < 0.001), and fluoroquinolones (OR 5.238, p = 0.012). The mortality risk was significantly higher among colonized (OR 2.356, p < 0.001) and colonized-infected (OR 2.000, p = 0.009) patients and in those with Enterobacter cloacae colonization (OR 5.173, p < 0,001) and previous aminopenicillins exposure (OR 3.452, p = 0.007). Conclusions Early detection of CRE colonization through screening testing proved to be an important tool to control CRE spread. However, observation over the years has shown no effective control of colonization and infection. The prevalence rates of CRE colonization and colonization-infection were high, as were the mortality rates. In conclusion, an active CRE surveillance protocol is essential, but its impact depends on the effective implementation of preventive measures and feedback between team members.

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“…The identification of clones responsible for the spread of resistance determinants as well as the detection of emerging clones highlight the evolutionary dynamics of bacterial strains. Recent studies have identified the ED as an important reservoir for CRE colonization, highlighting the need to address infection control in the ED in order to better manage carbapenem resistance in other wards [ 30 , 31 ]. Our results, on the other hand, show entrance from ED as a protective factor.…”

Section: Discussionmentioning

confidence: 99%

Carriage of Carbapenem-Resistant Enterobacterales in Adult Patients Admitted to a University Hospital in Italy

Barbadoro

Bencardino

Carloni³

et al. 2021

Antibiotics

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The emerging spread of carbapenemase-producing Enterobacterales (CPE) strains, in particular, Klebsiella pneumoniae and Escherichia coli, has become a significant threat to hospitalized patients. Carbapenemase genes are frequently located on plasmids than can be exchanged among clonal strains, increasing the antibiotic resistance rate. The aim of this study was to determine the prevalence of CPE in patients upon their admission and to analyze selected associated factors. An investigation of the antibiotic resistance and genetic features of circulating CPE was carried out. Phenotypic tests and molecular typing were performed on 48 carbapenemase-producing strains of K. pneumoniae and E. coli collected from rectal swabs of adult patients. Carbapenem-resistance was confirmed by PCR detection of resistance genes. All strains were analyzed by PCR-based replicon typing (PBRT) and multilocus sequence typing (MLST) was performed on a representative isolate of each PBRT profile. More than 50% of the strains were found to be multidrug-resistant, and the blaKPC gene was detected in all the isolates with the exception of an E. coli strain. A multireplicon status was observed, and the most prevalent profile was FIIK, FIB KQ (33%). MLST analysis revealed the prevalence of sequence type 512 (ST512). This study highlights the importance of screening patients upon their admission to limit the spread of CRE in hospitals.

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Increased Risk for Carbapenem-ResistantEnterobacteriaceaeColonization in Intensive Care Units after Hospitalization in Emergency Department

Cited by 34 publications

References 26 publications

<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients

Carriage of Carbapenem-Resistant Enterobacterales in Adult Patients Admitted to a University Hospital in Italy

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