Is surveillance for colonization of carbapenem-resistant gram-negative bacteria important in adult bone marrow transplantation units?

Demiraslan, Hayati; Cevahir, Fatma; Berk, Elife; Metan, Gökhan; Çetın, Mustafa; Alp, Emine

doi:10.1016/j.ajic.2017.01.006

Cited by 29 publications

(20 citation statements)

References 24 publications

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“…The emergence of carbapenem-resistant Enterobacteriaceae (CRE) strains is a major burden for public health-care systems, 39,40 with long-term surveillance studies identifying emerging high-risk strains of CRKP. 41,42 Here, we analyzed a 14-year time-window for trends in resistance phenotypes, virulence factors and sequence profiles of CRKP isolates from a major hospital in Wenzhou. This study enabled an in-depth look at a single major hospital within the time-frame of the national surveillance averages gathered through CHINET.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in Wenzhou, China from 2003 to 2016

Zhao

Zhang

Fang

et al. 2020

IDR

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Purpose: To investigate transitions in resistance mechanisms, virulence characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) during 2003-2016 in a major Eastern Chinese medical center. Patients and Methods: From a total of 2299 K. pneumoniae clinical strains collected from 2003 to 2016, 214 were found to be CRKP isolates and were selected for further study. Characterization of these was conducted by molecular detection of antibiotic resistance markers and virulence determinants, modified carbapenem inactivation method and multilocus sequence typing (MLST). Results: In this study, the prevalence of CRKP was increasing over the 14-year period, mirroring a national trend. These CRKP strains were resistant to most of the tested, clinically relevant drugs. The majority of these CRKP strains were positive for carbapenemases, with the Klebsiella pneumoniae carbapenemase (KPC) found to be the dominant type (207/210, 98.6%). The carrier rates of virulence genes uge, entB, fimH, mrkD and ureA increased in 2016, while the ybtA, iucA and irp2 showed a relatively constant trend. From MLST data, ST11 (88.8%, 190/ 214) was the preponderant sequence type (ST), followed by ST15 (1.9%, 4/214) and ST656 (1.4%, 3/214). Several strains with less common STs (ST690, ST895, ST1823 and ST1384) were also detected, and these too showed high levels of antimicrobial resistance. Conclusion: The average national rise in CRKP across China is mirrored in this in-depth analysis of a single hospital, while the prevalence of hypervirulent CRKP (such as ST15) was relatively low as of 2016. Continuous monitoring is necessary to keep track of CRKP and should include the prospect of newly emerging strains with less common STs and the prospect of detecting carbapenem-resistant, carbapenemase-negative Klebsiella pneumoniae.

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Section: Discussionmentioning

confidence: 99%

Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in Wenzhou, China from 2003 to 2016

Zhao

Zhang

Fang

et al. 2020

IDR

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“…The risk factors for colonizing Gram-negative rod-producing carabapenemases are the same as for the previously mentioned microorganisms, but in this case, colonization is primarily associated with hospitalization in a facility with high incidence of infections caused by carbapenemase-producing rods [33]. About 39.0% of all patients remained colonized with Gram-negative-rod-producing carabapenemases for up to one year.…”

Section: Discussionmentioning

confidence: 74%

Microbiological monitoring in patients with advanced ovarian cancer before and after cytoreductive surgery – a preliminary report

Szymankiewicz

Koper

Dziobek

et al. 2017

Current Issues in Pharmacy and Medical Sciences

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Multidrug-resistant organisms (MDROs) are becoming an increasing problem in hospitals. It is believed that screening patients for the incidence of MDROs prior to hospital admission not only allows for the proper management of infection following medical procedures, but can also potentially reduce the transmission of these bacteria to other patients. The aim of this study was to assess the carriers of selected MDROs in the gastrointestinal tract among patients with advanced ovarian cancer admitted to the hospital for cytoreductive surgery and to estimate the possible relationship between rectal colonization with these organisms and nosocomial infections. From December 2013 to May 2014, we evaluated the colonization with VRE (vancomycin-resistant Enterococcus), E. coli KPC+ (class A carbapenemase producing Escherichia coli), E. coli MBL+ (class B carbapenemase, metallo-ß lactamase producing Escherichia coli), and E. coli ESBL+ (extended-spectrum ß-lactamase producing Escherichia coli) in 42 patients. The patients were divided into two subgroups corresponding to the extent of their surgery: the first subgroup consisted of patients with large bowel resection (n=18) and the second subgroup of patients without resection (n=24). A rectal swab was taken within 24 hours of admission. Perioperative infectious complications were analyzed for the first 90 days following surgery with regard to the type of infection and the occurrence of examined MDROs. In our study, 2.4 % of all patients (23.8/1,000 hospitalizations) were colonized with ESBL - producing Escherichia coli: 0.0 % in the first subgroup and 4.2% in the second subgroup, respectively. We did not identify any patients who were colonized with VRE, E. coli MBL+, or E. coli KPC+. Surgical site infections were seen in 8 (19.1%) out of 42 patients. We were, therefore, unable to confirm a relationship between MDROs colonizing the large bowel and the etiological agents of perioperative infections. However, despite the lack of identification of MDROs as etiological agents of postoperative infection, the risk of serious infectious complications, combined with the changing epidemiological situation, means that microbiological monitoring should be performed in patients with ovarian cancer before and after cytoreductive surgery.

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“…A study at our center, in the 2014-2015 period, also reported that colonization by previous MDRO was associated with BSI (p < 0.001), with 20% of patients colonized by GNB-MDR developed BSI by these agents [3]. Other studies have also found similar ndings [12,13] Therefore, strategies for selective decolonization of the gastrointestinal tract (SDD) have been evaluated. A single center study demonstrated costeffectiveness of SDD in CRE colonized patients in intensive care units [14].…”

Section: Discussionmentioning

confidence: 89%

Usefulness of surveillance Cultures for Carbapenem-resistant Enterobacteriaceae, Carbapenem-resistant Pseudomonas aeruginosa and Vancomycin-resistant Enterococci in Hematopoietic Stem Cell Transplant Unit

Mendes

Salomão

Tomichi³

et al. 2020

Preprint

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Surveillance strategies to detect colonization is an important tool to prevent and control the spread of microorganisms especially among Hematopoietic Stem Cell Transplant (HSCT) patients. Colonization by Multidrug-resistant organisms (MDRO) has been evaluated as a risk factor for blood stream infection (BSI) in HSCT patients. The aim of this study was to evaluate the use of routine surveillance culture to screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa) and vancomycin-resistant enterococci (VRE) in a HSCT unit. Methods Surveillance cultures were collected from patients admitted to the HSCT unit over one-year, with swabs for cultures on admission and then weekly until discharge. We compared surveillance culture positivity for each site and agent, also clinical and epidemiological data according to the colonization status. Results 200 HSCT patients underwent surveillance, with 1.323 samples collected. Infection due to MDRO occurred in 52 (21.5%) patients, among them 45 (86.5%) were blood stream infection (BSI) and 12 (23%) had positive surveillance culture before infection. 554 (41.8%) surveillance cultures were performed for CRPa, 413 (31.2%) for VRE, and 356 (27%) for CRE. Of these, 179 (13.5%) surveillance culture were positive, with greater positivity for oropharynx (6, 35.3%) CRPa, and rectal samples (16, 20.7%) for CRE. Being colonized by any MDRO, CRE (p <0.001) and CRPa (p = 0.027) was associated with a higher risk of infection in the bivariate analysis but being colonized was not associated with risk of death. Conclusion Previous colonization by MDRO was a significant risk factor for infection by these pathogens, mainly colonization by CRE. Overall, rectal swab was the best site with the higher positivity, and the oropharynx was also an option for CRPa investigation. Feces culture showed low positivity and should be avoided. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, VRE surveillance should be questioned in auto-HSCT patients as it has an additional cost and little impact on survival.

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Is surveillance for colonization of carbapenem-resistant gram-negative bacteria important in adult bone marrow transplantation units?

Cited by 29 publications

References 24 publications

<p>Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant <em>Klebsiella pneumoniae</em> in Wenzhou, China from 2003 to 2016</p>

<p>Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant <em>Klebsiella pneumoniae</em> in Wenzhou, China from 2003 to 2016</p>

Microbiological monitoring in patients with advanced ovarian cancer before and after cytoreductive surgery – a preliminary report

Usefulness of surveillance Cultures for Carbapenem-resistant Enterobacteriaceae, Carbapenem-resistant Pseudomonas aeruginosa and Vancomycin-resistant Enterococci in Hematopoietic Stem Cell Transplant Unit

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