Prevalence of Invasive Infections Due to Carbapenem-Resistant Enterobacteriaceae among Adult Patients in U.S. Hospitals

Abstract

This large-scale retrospective analysis (n ϭ 60,551) of the Premier inpatient database (1 January 2011 to 31 December 2014) found an overall prevalence of carbapenem-resistant Enterobacteriaceae strains of 2.3% (range, 0.9% to 5.8% by geographic region) among patients with infections due to Enterobacteriaceae. Ongoing monitoring and development of decision support tools/algorithms are needed for identification of high-risk patients.KEYWORDS bacterial drug resistance, anti-infective agents, carbapenems, bacterial infections, urinary tract infections, intra-abdominal infections, bacterial pneumonia, bacteremia A lthough the U.S. Centers for Disease Control and Prevention (CDC) identifies infections due to carbapenem-resistant Enterobacteriaceae (CRE) as an urgent public health threat (1), limited data exist regarding the true prevalence of these infections among adult hospitalized patients. Existing surveillance programs potentially underestimate prevalence owing to limited site participation and clinical specimen availability. This study sought to quantify the prevalence of carbapenem resistance in invasive infections due to Enterobacteriaceae among adult hospitalized patients within 9 geographic regions across the United States.(Preliminary results from this study were presented at the Society for Healthcare Epidemiology of America Spring 2015 Conference, 14 -17 May, 2015, Orlando, FL.) To accomplish the study objectives, a retrospective observational study was performed using hospital discharge data from approximately 178 U.S. health care facilities in the Premier research database with accessible microbiology results (see Appendix A in the supplemental material). In total, the Premier hospital database includes data from approximately 80 million admissions (Ͼ5 million added per year since 2011). Admissions data are provided by Ͼ500 participating acute care hospitals from across the United States and account for approximately 20% of all inpatient discharges in the nation (Premier Healthcare Database: Data that Informs and Performs, Premier, Inc., Charlotte, NC). The infective episode for a patient was included if all of the following criteria were met: (i) patient Ն18 years of age; (ii) inpatient discharge between 1 January 2011 and 31 December 2014; (iii) primary or secondary diagnosis at discharge using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes of complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), hospital-associated pneumonia (HAP), or bloodstream infection (BSI) (see Appendix B in the supplemental material); (iv) positive culture for an Enterobacteriaceae strain obtained from a site consistent with the infection type (see Appendix C in the supplemental material); (v) receipt of antibiotic treatment on day of Enterobacteriaceae culture collection or Յ3 days after index Enterobacteriaceae culture; and (vi) available susceptibility data for the index isolate.Cohorts by infection type were not mutually excl...

Imipenem‐Cilastatin‐Relebactam: A Novel β‐Lactam–β‐Lactamase Inhibitor Combination for the Treatment of Multidrug‐Resistant Gram‐Negative Infections

“…Among these resistance mechanisms are β‐lactamases that inactivate carbapenems such as serine carbapenemases (KPC, IMI), metallo‐β‐lactamases (VIM, NDM), and several OXA enzymes, as well as mutations that cause the loss of porin channels . In the United States, data suggest that 2.3% of all infections due to Enterobacteriaceae possess carbapenem resistance . In the presence of relebactam, imipenem minimum inhibitory concentrations (MICs) have been reliably reduced in a number of in vitro studies, although relebactam does not restore susceptibility in isolates carrying metallo‐ β‐lactamases .…”

“…51 In the United States, data suggest that 2.3% of all infections due to Enterobacteriaceae possess carbapenem resistance. 52 In the presence of relebactam, imipenem minimum inhibitory concentrations (MICs) have been reliably reduced in a number of in vitro studies, although relebactam does not restore susceptibility in isolates carrying metallo-β-lactamases. 48 The following paragraphs and Table 1 describe available susceptibility testing data for IMI-REL.…”

Characteristics of Carbapenem-Resistant Enterobacteriaceae in Ready-to-Eat Vegetables in China

“…The emergence of carbapenem-resistant Enterobacteriaceae (CRE) is of great concern to public health, and CRE isolates have been found in samples of different origins around the world in recent years, including humans (Singh-Moodley and Perovic, 2016 ; Lodise et al, 2017 ; Zhang et al, 2017 ), hospital wastewater (Lamba et al, 2017 ), animals (Liu et al, 2017 ), seafood products (Morrison and Rubin, 2015 ), and retail meat (Wang et al, 2017 ). In fresh vegetables, one Klebsiella variicola producing OXA-181 and three Klebsiella pneumoniae producing OXA-48 were found in Switzerland (Zurfluh et al, 2015b ) and Algeria (Touati et al, 2017 ), respectively.…”

Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

“…Carbapenem-resistance among gram-negative bacteria (GNB), including Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacteriaceae, has significantly increased all over the world and poses a significant threat to public health [ 1 , 2 , 3 ]. Most importantly, the infections, such as ventilator-associated pneumonia (VAP), bloodstream infection (BSI), and complicated intra-abdominal infection (IAI) caused by carbapenem-resistant bacteria, are associated with high morbidity and mortality [ 4 , 5 , 6 ].…”