"Silent" Dissemination of Klebsiella pneumoniae Isolates Bearing K. pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio

Viau, Roberto; Hujer, Andrea M.; Marshall, Steven H.; Pérez, Federico; Hujer, Kristine M.; Briceño, David; Dul, Michael; Jacobs, Michael; Grossberg, Richard; Toltzis, Philip; Bonomo, Robert A.

doi:10.1093/cid/cis036

Cited by 75 publications

(66 citation statements)

References 38 publications

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“…Such a mixture of horizontal gene transfer and clonal expansion has been demonstrated elsewhere in the United States with plasmid linkage and clonal typing (42)(43)(44). bla SME and bla NDM-1 carbapenemases were detected in this study.…”

Section: Discussionsupporting

confidence: 78%

“…Intuitively, such carbapenemases associated with a susceptible phenotype may not be clinically significant, although animal data suggest carbapenem treatment failure with such carbapenemase producers regardless of the susceptible-range MICs (60). Finally, we only considered clinically significant isolates, and this likely underestimates the burden of colonized patients, which may effectively spread CRE through the region, LTACH, and SNFs (43). Given that CRE are increasing in this region, increasing escalation of local infection control measures beyond core measures to active surveillance may be useful, as suggested by the CDC (14).…”

Section: Discussionmentioning

confidence: 99%

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Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

et al. 2014

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c Carbapenem-resistant Enterobacteriaceae (CRE) are a concern for health care in the United States but remain relatively uncommon in California. We describe the phenotype, clonality, and carbapenemase-encoding genes present in CRE isolated from patients at a Californian tertiary health care system. CRE for this study were identified by evaluating the antibiograms of Enterobacteriaceae isolated in the UCLA Health System from 2011 to 2013 for isolates that were not susceptible to meropenem and/or imipenem. The identification of these isolates was subsequently confirmed by matrix-associated laser desorption ionizationtime of flight, and broth microdilution tests were repeated to confirm the CRE phenotype. Real-time PCR for bla KPC , bla SME , bla IMP , bla NDM-1 , bla VIM , and bla OXA-48 was performed. Clonality was assessed by repetitive sequence-based PCR (repPCR) and multilocus sequence typing (MLST). Of 15,839 nonduplicate clinical Enterobacteriaceae isolates, 115 (0.73%) met the study definition for CRE. This number increased from 0.5% (44/8165) in the first half of the study to 0.9% (71/7674) in the second (P ‫؍‬ 0.004). The most common CRE species were Klebsiella pneumoniae, Enterobacter aerogenes, and Escherichia coli. A carbapenemase-encoding gene was found in 81.7% (94/115) of CRE and included bla KPC (78.3%), bla NDM-1 (0.9%), and bla SME (2.6%). The majority of bla KPC genes were in K. pneumoniae isolates, which fell into 14 clonal groups on typing. bla KPC was identified in more than one species of CRE cultured from the same patient in four cases. Three bla SME -carrying Serratia marcescens isolates and one bla NDM-1 carrying Providencia rettgeri isolate were detected. CRE are increasing in California, and carbapenemases, particularly KPC, are a common mechanism for carbapenem resistance in this region.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

et al. 2014

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“…Molecular characterization in conjunction with phenotypic reporting by clinical microbiology laboratories can provide a "snapshot" of enzymes present within a geographical area, can support antibiogram data and reveal β-lactamases that are "silently disseminating" [24] [25]. Genotypic results from systems such as the one used in this study may answer the question: "are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?"…”

Section: Discussionmentioning

confidence: 96%

“…In Enterobacter species, 10/27 (37%) harbored ESBLs and 20/27 (74%) possessed plasmid mediated β-lactamases including ACT/MIR (17/27, 63%), DHA (2/27, 7%) and FOX (1/27, 4% No NDM, VIM, IMP, GIM or SPM metallo-β-lactamases were identified in any of the isolates. Pseudomonas aeruginosa (24) 3/24 1/24…”

Section: Dna Isolation and Amplificationmentioning

confidence: 99%

Detection and Characterization of <i>β</i>-Lactamase Encoding Genes in Carbapenem Non-Susceptible Gram-Negative Bacteria and Susceptibility of Isolates to Ceftazidime-Avibactam at a New York City Community Hospital

Urban¹,

Colon-Urban²,

LaBombardi³

et al. 2016

OJMM

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A surveillance study was undertaken to identify prominent β-lactamase encoding genes in 131 carbapenem non-susceptible gram-negative clinical isolates at a New York City community hospital. KPC carbapenemases were detected in 89% of Enterobacteriaceae as well as additional TEM, SHV, and CTX-M class A enzymes. OXA-23 and OXA-24 were the prevalent class D carbapenemases identified in Acinetobacter species. One OXA-23 in M. morganii and one OXA-48 in K. pneumoniae were also identified. Among class C β-lactamases CMY, ACT/MIR, DHA, and FOX were detected. The in vitro activity of ceftazidime-avibactam by E-test methodology was tested with minimal inhibitory concentrations (MIC) of ≤3 µg/ml for 97.8% of all Enterobacteriaceae, MIC 50/90 of 16/>256 µg/ml for carbapenem non-susceptible Acinetobacter, and 3/6 µg/ml for carbapenem non-susceptible Pseudomonas aeruginosa. Periodic surveillance of isolates to characterize current and emerging β-lactamase genotypes present in local isolates may help identify outbreak situations, provide assistance to infection control and antibiotic stewardship programs, and potentially improve patient outcomes.

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“…Infections with these organisms are associated with higher mortality rates than those infections with more susceptible strains (6,7). Patients who are asymptomatic carriers can serve as a source for nosocomial spread of these carbapenem-resistant organisms, necessitating the prompt detection of carriers and institution of appropriate infection control measures (8)(9)(10)(11). Surveillance for CRE is especially useful among immunocompromised patients, including those in intensive care and transplant units (11,12).…”

mentioning

confidence: 99%

Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

LaBombardi

Urban²,

Kreiswirth

et al. 2015

J Clin Microbiol

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We compared the Remel Spectra CRE agar plate to CDC standard methodology for the isolation of carbapenem-resistant Enterobacteriaceae (CRE) from 300 rectal swab specimens obtained from patients residing in a long-term-care facility (LTCF). Multiplex PCR experiments were performed on isolates to identify specific Klebsiella pneumoniae carbapenemases (KPC) and additional ␤-lactamases. Of the 300 patients, 72 (24%) harbored CRE and were PCR positive for KPC enzymes. The Remel Spectra CRE plates detected KPC-type CRE in isolates from 70 of 72 patients (97.2%), while the CDC method detected CRE in 56 of 72 (77.8%). CRE identification results were available in 18 h compared to 36 h for the CDC method. Remel Spectra CRE agar plates can provide useful means for a fast and reliable method for detecting KPC-type CRE and for accelerated institution of appropriate infection control precautions. K lebsiella pneumoniae carbapenemases (KPC) are predominantly found in Klebsiella pneumoniae worldwide and have become endemic in major cities of the United States (1-4). They have also been characterized in Klebsiella oxytoca, Escherichia coli, Enterobacter spp., Citrobacter spp., Serratia spp., Acinetobacter baumannii, Salmonella spp., and Pseudomonas spp (1-3). Although KPC-type carbapenemases are the leading cause of carbapenem resistance among Enterobacteriaceae (CRE) in the United States, carbapenem resistance can be mediated by many other enzymes alone or in combination with other resistance mechanisms, including efflux and porin mutations (3, 5). Infections with these organisms are associated with higher mortality rates than those infections with more susceptible strains (6, 7). Patients who are asymptomatic carriers can serve as a source for nosocomial spread of these carbapenem-resistant organisms, necessitating the prompt detection of carriers and institution of appropriate infection control measures (8-11). Surveillance for CRE is especially useful among immunocompromised patients, including those in intensive care and transplant units (11,12). Screening residents of long-term-care facilities (LTCF) prior to admission and/or transfer to a hospital may be of increasing importance, as they may harbor antibiotic-resistant isolates (13-15). Although they are rapid, PCR-based technologies can be expensive and limited, as they only interrogate specific genes that are being screened and a positive result does not always predict the expression of resistance. While traditional culture methods are slow and may lack sensitivity, the use of chromogenic media to culture CRE and other multidrug-resistant microorganisms (MDRO) may facilitate the detection of these organisms in a timelier manner (16-18). The purpose of this investigation was to compare Remel Spectra CRE agar plates to the standard CDC method for the isolation of CRE from rectal swab specimens obtained from patients residing in an LTCF. Remel Spectra CRE agar is a selective and differential agar intended for use in the qualitative and presumptive identification of carbape...

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"Silent" Dissemination of Klebsiella pneumoniae Isolates Bearing K. pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio

Cited by 75 publications

References 38 publications

Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

Detection and Characterization of <i>β</i>-Lactamase Encoding Genes in Carbapenem Non-Susceptible Gram-Negative Bacteria and Susceptibility of Isolates to Ceftazidime-Avibactam at a New York City Community Hospital

Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

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"Silent" Dissemination of Klebsiella pneumoniae Isolates Bearing K. pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio

Cited by 75 publications

References 38 publications

Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

Phenotypic and Molecular Characteristics of Carbapenem-Resistant Enterobacteriaceae in a Health Care System in Los Angeles, California, from 2011 to 2013

Detection and Characterization of &lt;i&gt;β&lt;/i&gt;-Lactamase Encoding Genes in Carbapenem Non-Susceptible Gram-Negative Bacteria and Susceptibility of Isolates to Ceftazidime-Avibactam at a New York City Community Hospital

Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

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Detection and Characterization of <i>β</i>-Lactamase Encoding Genes in Carbapenem Non-Susceptible Gram-Negative Bacteria and Susceptibility of Isolates to Ceftazidime-Avibactam at a New York City Community Hospital