Risk Factors for Carbapenem-Resistant
            <i>Enterobacterales</i>
            Clinical Treatment Failure

Rebold, Nicholas; Lagnf, Abdalhamid M; Alosaimy, Sara; Holger, Dana; Witucki, Paige; Mannino, Andrew; Dierker, Michelle; Lucas, Kristen; Coyne, Ashlan J Kunz; Ghali, Amer El; Caniff, Kaylee E; Veve, Michael P; Rybak, Michael J.

doi:10.1128/spectrum.02647-22

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…In addition, CRE and CRA have been reported as the most urgent threats by the CDC since 2019 [ 1 ]. Particularly, CRE results in 1100 deaths and 13,100 infections in the USA [ 1 ], with a high fraction of these infections potentially resulting in death due to limited antibiotic therapies [ 1 , 22 , 30 ].…”

Section: Urgent Threat Of Infections By Antimicrobial Resistant Bacte...mentioning

confidence: 99%

“…Such infections are high risk for patients using ventilators, urinary catheters, intravenous catheters, and long-term antibiotic treatment and for immunocompromised patients [ 41 ]. A significant fraction of these infections result in death due to limited treatment options [ 1 , 22 , 30 , 44 ]. Specifically, bloodstream infection by CRE causes a high mortality rate in pediatric populations [ 40 , 45 ].…”

Section: Urgent Threat Of Infections By Antimicrobial Resistant Bacte...mentioning

confidence: 99%

“…AMR also puts at risk those who receive modern healthcare advances, such as joint replacements, organ transplants, cancer therapy, etc. These procedures have a risk of infection, and effective antibiotics may not be available [ 1 , 30 ]. AMR is a global crisis, and new forms of resistance emerge and rapidly spread across countries and continents through people, goods, and animals.…”

Section: Introductionmentioning

confidence: 99%

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A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques

Caliskan-Aydogan

Alocilja

2023

Microorganisms

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Infectious disease outbreaks have caused thousands of deaths and hospitalizations, along with severe negative global economic impacts. Among these, infections caused by antimicrobial-resistant microorganisms are a major growing concern. The misuse and overuse of antimicrobials have resulted in the emergence of antimicrobial resistance (AMR) worldwide. Carbapenem-resistant Enterobacterales (CRE) are among the bacteria that need urgent attention globally. The emergence and spread of carbapenem-resistant bacteria are mainly due to the rapid dissemination of genes that encode carbapenemases through horizontal gene transfer (HGT). The rapid dissemination enables the development of host colonization and infection cases in humans who do not use the antibiotic (carbapenem) or those who are not hospitalized but interacting with environments and hosts colonized with carbapenemase-producing (CP) bacteria. There are continuing efforts to characterize and differentiate carbapenem-resistant bacteria from susceptible bacteria to allow for the appropriate diagnosis, treatment, prevention, and control of infections. This review presents an overview of the factors that cause the emergence of AMR, particularly CRE, where they have been reported, and then, it outlines carbapenemases and how they are disseminated through humans, the environment, and food systems. Then, current and emerging techniques for the detection and surveillance of AMR, primarily CRE, and gaps in detection technologies are presented. This review can assist in developing prevention and control measures to minimize the spread of carbapenem resistance in the human ecosystem, including hospitals, food supply chains, and water treatment facilities. Furthermore, the development of rapid and affordable detection techniques is helpful in controlling the negative impact of infections caused by AMR/CRE. Since delays in diagnostics and appropriate antibiotic treatment for such infections lead to increased mortality rates and hospital costs, it is, therefore, imperative that rapid tests be a priority.

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Section: Urgent Threat Of Infections By Antimicrobial Resistant Bacte...mentioning

confidence: 99%

Section: Urgent Threat Of Infections By Antimicrobial Resistant Bacte...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques

Caliskan-Aydogan

Alocilja

2023

Microorganisms

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“…Enterobacterales are the most common pathogenic Gram-negative bacteria responsible for severe nosocomial infections ( 1 , 2 ). In particular, the worldwide occurrence of carbapenem-resistant Enterobacterales (CRE) infections has increased in recent years, including China, representing a considerable public health challenge ( 3 – 6 ). In early 2017, the World Health Organization (WHO) released a list of drug-resistant bacteria, including CRE, that pose a substantial threat to human health, highlighting the urgent need to develop new antibiotics ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical risk factors and outcomes of carbapenem-resistant Escherichia coli nosocomial infections in a Chinese teaching hospital: a retrospective study from 2013 to 2020

Kong,

Hu,

Zhang

et al. 2024

Microbiol Spectr

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The emergence of carbapenem-resistant Escherichia coli strains poses a considerable challenge to global public health, and little is known about carbapenemase-producing E. coli strains in Tianjin, China. This study aimed to investigate the risk factors for infections with carbapenem-resistant E. coli (CREC) strains. This retrospective case–control study was conducted at a tertiary teaching hospital. A total of 134 CREC clinical isolates were collected from the General Hospital of Tianjin Medical University between 2013 and 2020. The control group was selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible E. coli infection. Risk factors for nosocomial CREC infection and clinical outcomes were analyzed using univariate and multivariate analyses. Multivariate analysis revealed that cephalosporin exposure (odd ratio OR = 2.01), carbapenem exposure (OR = 1.96), glucocorticoid exposure (OR = 32.45), and surgical history (OR = 3.26) were independent risk factors for CREC infection. The in-hospital mortality rate in the CREC group was 29.1%, and age >65 years (OR = 3.19), carbapenem exposure (OR = 3.54), and central venous catheter insertion (OR = 4.19) were independent risk factors for in-hospital mortality in patients with CREC infections. Several factors were identified in the development of nosocomial CREC infections. The CREC isolates were resistant to most antibiotics. Reducing CREC mortality requires a comprehensive consideration of appropriate antibiotic use, underlying diseases, and invasive procedures. IMPORTANCE Escherichia coli is an opportunistic pathogen that causes severe hospital-acquired infections. The spread of carbapenem-resistant E. coli is a global threat to public health, and only a few antibiotics are effective against these infections. Consequently, these infections are usually associated with poor prognosis and high mortality. Therefore, understanding the risk factors associated with the causes and outcomes of these infections is crucial to reduce their incidence and initiate appropriate therapies. In our study, several factors were found to be involved in nosocomial carbapenem-resistant E. coli (CREC) infections, and CREC isolates were resistant to most antibiotics. Reducing CREC mortality needs a comprehensive consideration of whether antibiotics are used appropriately, underlying diseases, and invasive interventions. These findings provide valuable evidence for the development of anti-infective therapy, infection prevention, and control of CREC-positive infections.

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Continuous infusion of meropenem–vaborbactam for a KPC-3-producing Klebsiella pneumoniae bloodstream infection in a critically ill patient with augmented renal clearance

et al. 2023

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Purpose To demonstrate the feasibility of continuous infusion of meropenem–vaborbactam to optimize the treatment of carbapenem-resistant Enterobacterales. Methods Report of a case of a Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bloodstream infection comfirmed by whole genome sequencing and therapeutic drug monitoring (TDM) of meropenem. Results A patient with augmented renal clearance (ARC) went into septic shock caused by an ST11 KPC-3-producing K. pneumoniae bloodstream infection that was successfully treated with a continuous infusion of meropenem–vaborbactam at a dosage of 1 g/1 g q4h as a 4-h infusion. TDM confirmed sustained concentrations of meropenem ranging from 8 to 16 mg/L throughout the dosing interval. Conclusion Continuous infusion of meropenem–vaborbactam was feasible. It could be appropriate for optimizing the management of critically ill patients with ARC, as it resulted in antibiotic concentrations above the minimum inhibitory concentration for susceptible carbapenem-resistant Enterobacterales (up to 8 mg/L) throughout the dosing interval.

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Risk Factors for Carbapenem-Resistant Enterobacterales Clinical Treatment Failure

Cited by 7 publications

References 27 publications

A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques

A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques

Clinical risk factors and outcomes of carbapenem-resistant Escherichia coli nosocomial infections in a Chinese teaching hospital: a retrospective study from 2013 to 2020

Continuous infusion of meropenem–vaborbactam for a KPC-3-producing Klebsiella pneumoniae bloodstream infection in a critically ill patient with augmented renal clearance

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