Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

Bhargava, Ashish; Hayakawa, Kayoko; Silverman, Ethan; Haider, Samran; Alluri, Krishna; Datla, Satya; Diviti, Sreelatha; Kuchipudi, Vamsi; Muppavarapu, Kalyan; Lephart, Paul; Marchaim, Dror; Kaye, Keith S.

doi:10.1086/675614

Cited by 82 publications

(64 citation statements)

References 34 publications

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“…Our study identified similar risk factors that other investigators have highlighted in their studies done in 2014 and 2015 prior exposure to antimicrobials such as 3 rd generation cephalosporins, carbapenems and beta-lactam/beta-lactamase inhibitor combinations, admission to ICU, presence to indwelling devices for example urinary catheter, central line, endotracheal tube, and prior hospitalization [9,10]. This highlights the importance of safe patient care practices, especially in the care of devices as well as the significance of an antimicrobial stewardship program in the strategy for the prevention of CRE infections.…”

Section: Discussionsupporting

confidence: 86%

Carbapenem-Resistant Enterobacteriaceae: New Menace to Our Antibiotic Armamentarium!

Porwal

Bhat

2017

Asian J Pharm Clin Res

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Objective: To study the risk factors, clinical characteristics, and outcome in patients with infections due to CRE infections. Methods:Retrospective study was carried out in a microbiology laboratory for 6 months. 152 CRE isolates identified by the Vitek 2 compact system were included in the study. The risk factors, antibiotic treatment and clinical outcome were studied from the case sheets, Chi-square test was used for statistical analysis.Results: Of the 2520 positive cultures for Enterobacteriaceae, isolation rate of CRE was 152 (6%). 76 (50%) belonged to exudates, 22 (14.1%) blood culture, 90 (59.2%) urine. The common infection was UTI. The risk factors were prior exposure to antimicrobials, admission to intensive care unit, indwelling devices and prior hospitalization. The effective antibiotic was colistin, polymyxin B, tigecycline, cefoperazone-sulbactum, piperacillintazobactum. The mortality was 19.7%. Conclusion:We have demonstrated the value of understanding local epidemiology to help modify our risk-based screening as a strategy to limit the spread of CRE.

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Section: Discussionsupporting

confidence: 86%

Carbapenem-Resistant Enterobacteriaceae: New Menace to Our Antibiotic Armamentarium!

Porwal

Bhat

2017

Asian J Pharm Clin Res

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“…LTACs, which are well known epidemiologically as focal points for concentrating CRE (12,22), would experience the greatest reduction in CRE prevalence with the new breakpoints, due to the use of contact precautions on a great number of identified carriers. The effects on LTACs are due to their having greater importation of CRE among admitted patients, generally higher transmission coefficients (calibrated based on studies in the literature [11][12][13][14]), longer patient LOS, smaller sizes (e.g., bed capacity), and substantial interconnectivity with other facilities. Although nursing homes did not perform surveillance testing, they do experience a decrease in prevalence due to the downstream effect of increased carrier detection leading to contact precautions that reduce transmission.…”

Section: Discussionmentioning

confidence: 99%

“…These target prevalence estimates were based on regional surveillance data and published literature (11)(12)(13)(14)(15). We then parameterized the ICU and non-ICU ward betas (Table 1), taking OC data into account, so that CRE prevalence trends matched those currently seen in OC facilities based on epidemiologic surveys conducted in year 4 of CRE emergence (16).…”

Section: Methodsmentioning

confidence: 99%

Impact of Delays between Clinical and Laboratory Standards Institute and Food and Drug Administration Revisions of Interpretive Criteria for Carbapenem-Resistant Enterobacteriaceae

et al. 2016

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g Delays often occur between CLSI and FDA revisions of antimicrobial interpretive criteria. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model, we found that the 32-month delay in changing carbapenem-resistant Enterobacteriaceae (CRE) breakpoints might have resulted in 1,821 additional carriers in Orange County, CA, an outcome that could have been avoided by identifying CRE and initiating contact precautions. Policy makers should aim to minimize the delay in the adoption of new breakpoints for antimicrobials against emerging pathogens when containment of spread is paramount; delays of <1.5 years are ideal. Delays often occur between the issuance of new diagnostic interpretive criteria for microbiology laboratories by standardsetting organizations, such as the Clinical and Laboratory Standards Institute (CLSI), and their adoption by the Food and Drug Administration (FDA) to inform breakpoints for the manufacturers of diagnostic tests. Delays occur due to the FDA's required regulatory processes and the necessity of generating data from pharmaceutical companies to support interpretive criteria changes. Quantifying the impact of such delays could help determine the value of addressing and rectifying their causes. A recent example is the 32-to 42-month delay (depending on the antimicrobial) between CLSI's release of moresensitive criteria for diagnosing carbapenem-resistant Enterobacteriaceae (CRE), beginning with M100-S20 issuances in 2010, and the conveyance of these new criteria to manufacturers by the FDA (1). Such a delay could result in CRE transmission if CRE carriers are missed (because old criteria are still in use) and are not placed on contact precautions to reduce CRE spread (2). This is of concern because CRE are considered an urgent public health threat by the Centers for Disease Control and Prevention (CDC) (3), and few treatment options exist for CRE infection, which can result in high mortality. Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated simulation model of Orange County, CA (OC) (4), we determined the impact of this delay on estimated (i.e., potential) CRE transmission within health care facilities. MATERIALS AND METHODSWe used our previously described Regional Healthcare Ecosystem Analyst (RHEA) software platform (4-6) to generate a detailed agent-based model of Orange County, CA, which included detailed representations of all 28 acute-care hospitals (including 5 long-term acute-care facilities [LTACs]) and 74 free-standing nursing homes serving adult patients, along with the patients flowing among these locations and the community at large. We utilized the RHEA OC model to simulate the spread of CRE (7, 8) and the impact of changing CRE breakpoints in the early stages of OC's epidemic (years 4 to 5). Our model drew from detailed 2011-2012 OC patient-level data for adult inpatient hospital and nursing home admissions (9, 10). Table 1 shows key model inputs.Briefly, the model represents each patient with a computational agent. As in real life, each virtual ...

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“…However, an epidemiologic study was not performed at our hospital. Asymptomatically colonized patients are known to be a reservoir for CRE and active surveillance is recommended for high risk patients with a Charlson's score greater than 3, immunosuppression, the presence of indwelling devices and prior antimicrobial exposures (20). Active surveillance, coupled with appropriate contact precautions and cohorting of carriers, have been an effective strategy to identify colonization and reduce the transmission of drug-resistant pathogens, and is also widely recognized (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

<i>Klebsiella oxytoca</i>-producing IMP-1 Detected as the First Strain of Carbapenem-resistant <i>Enterobacteriaceae</i> in Our Hospital

et al. 2015

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We herein report a case of Klebsiella oxytoca-producing IMP-1 that was detected as a first isolate of carbapenem-resistant Enterobacteriaceae (CRE) at our facility. Since K. oxytoca is an uncommon strain for CRE, we speculated that the resistant organism had already spread out inside the hospital. Metallo-β-lactamases promotes antibiotic resistance in Enterobacteriaceae, which potentially yields problematic issues in clinical settings. Active surveillance of antibiotic resistant strains is important and should be repeatedly highlighted. Furthermore, appropriate methods should be established to detect highly resistant strains.

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Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

Abstract: These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

Cited by 82 publications

References 34 publications

Carbapenem-Resistant Enterobacteriaceae: New Menace to Our Antibiotic Armamentarium!

Carbapenem-Resistant Enterobacteriaceae: New Menace to Our Antibiotic Armamentarium!

Impact of Delays between Clinical and Laboratory Standards Institute and Food and Drug Administration Revisions of Interpretive Criteria for Carbapenem-Resistant Enterobacteriaceae

<i>Klebsiella oxytoca</i>-producing IMP-1 Detected as the First Strain of Carbapenem-resistant <i>Enterobacteriaceae</i> in Our Hospital

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