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Comparing the Outcomes of Patients With Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia

Published on Feb 1, 2017in Clinical Infectious Diseases9.055
· DOI :10.1093/cid/ciw741
Pranita D. Tamma24
Estimated H-index: 24
(JHUSOM: Johns Hopkins University School of Medicine),
Katherine E. Goodman4
Estimated H-index: 4
(Johns Hopkins University)
+ 4 AuthorsPatricia J. Simner18
Estimated H-index: 18
(JHUSOM: Johns Hopkins University School of Medicine)
Sources
Abstract
Abstract Carbapenem-resistant Enterobacteriaceae (CRE) are associated with considerable mortality. As mechanisms of carbapenem resistance are heterogeneous, it is unclear if mortality differs based on resistance mechanisms. We sought to determine whether CRE resistance mechanism determination is prognostically informative. We conducted an observational study comparing 14-day mortality between patients with carbapenemase-producing (CP)-CRE compared with non-CP-CRE bacteremia. Clinical data were collected on all patients. A comprehensive DNA microarray-based assay was performed on all isolates to identify β-lactamase-encoding genes. There were 83 unique episodes of monomicrobial CRE bacteremia during the study period: 37 (45%) CP-CRE and 46 (55%) non-CP-CRE. The majority of CP-CRE isolates were bla KPC (92%), followed by bla NDM (5%) and bla OXA-48-type (3%). CP-CRE isolates were more likely to have meropenem minimum inhibitory concentrations (MICs) ≥16 µg/mL, while non-CP-CRE isolates were more likely to have meropenem MICs ≤1 µg/mL (P value
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References25
Newest
#1Pranita D. Tamma (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 24
#2Yanjie Huang (Johns Hopkins University)H-Index: 2
Last. Patricia J. Simner (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 18
view all 4 authors...
ABSTRACT Carbapenemase-producing (CP) Enterobacteriaceae are largely responsible for the rapid spread of carbapenem-resistant Enterobacteriaceae (CRE). Distinguishing CP-CRE from non-CP-CRE has important infection control implications. In a cohort of 198 CRE isolates, for isolates that remained susceptible or intermediate to some carbapenem antibiotics, an ertapenem MIC of 0.5 μg/ml and meropenem, imipenem, and doripenem MICs of 2 μg/ml were best able to distinguish CP-CRE from non-CP-CRE isolat...
10 CitationsSource
#2Christian PallaresH-Index: 5
Last. Manuel Guzman-BlancoH-Index: 14
view all 16 authors...
Introduction Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy. Methods Between July 2013 and...
21 CitationsSource
#1Katherine E. Goodman (Johns Hopkins University)H-Index: 4
#2Patricia J. Simner (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 18
Last. Aaron M. Milstone (Johns Hopkins University)H-Index: 29
view all 4 authors...
The Centers for Disease Control and Prevention (CDC) defines carbapenem-resistant Enterobacteriaceae (CRE) based upon a phenotypic demonstration of carbapenem resistance. However, considerable hete...
26 CitationsSource
#1Yedidah Fraenkel-Wandel (Shaare Zedek Medical Center)H-Index: 2
#2David Raveh-Brawer (Shaare Zedek Medical Center)H-Index: 2
Last. Marc Victor Assous (Shaare Zedek Medical Center)H-Index: 12
view all 5 authors...
To determine the mortality rate secondary to blaKPC Klebsiella pneumoniae (KPC/Kp) bacteraemia, compared with that from ESBL-producing K. pneumoniae (ESBL/Kp) bacteraemia, and to determine associated risk factors.This was a retrospective case-control study of all 68 KPC/Kp bacteraemia patients diagnosed since 2006, matched by year of isolation, gender and age, at a ratio of 1:2, to 136 ESBL/Kp bacteraemia patients.There were no demographic differences between the two groups, but there were minor...
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#1Nora Chea (CDC: Centers for Disease Control and Prevention)H-Index: 12
#2Sandra N. Bulens (CDC: Centers for Disease Control and Prevention)H-Index: 20
Last. Alexander J. Kallen (CDC: Centers for Disease Control and Prevention)H-Index: 33
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Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non–CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (...
28 CitationsSource
#1S. AmitH-Index: 1
#2Hagit MishaliH-Index: 5
Last. Yehuda CarmeliH-Index: 72
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Abstract Carriers of carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasingly recognised through active surveillance in much of the world. We studied incidence, aetiology and predictors of bloodstream infections (BSI) among such carriers. Via a retrospective cohort study conducted in a tertiary care teaching hospital, we examined occurrence of BSI within 45 days of CRKP carrier detection. Three nested case-control studies were conducted to analyse parameters associated with all-cause (...
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#1Ilker Inanc Balkan (Istanbul University)H-Index: 12
#2Gokhan Aygun (Istanbul University)H-Index: 8
Last. Recep Ozturk (Istanbul University)H-Index: 28
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Summary Background Blood stream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) are associated with high hospital mortality rates and present a tremendous challenge to clinicians. The optimal treatment remains undefined. We aimed to investigate the risk factors for mortality and the correlation between different treatment modalities and outcomes. Methods The clinical characteristics and treatment outcomes of a cohort of 36 patients with BSIs due to CRE were investigated an...
35 CitationsSource
#1Matthaios Papadimitriou-Olivgeris (University of Patras)H-Index: 9
#2Markos Marangos (University of Patras)H-Index: 19
Last. Evangelos D. Anastassiou (University of Patras)H-Index: 20
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AbstractBackground: Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections in intensive care units (ICUs) are associated with increased mortality. We aimed to determine risk factors for infection and predictors of 30-day mortality in ICU patients with KPC-Kp bloodstream infections (BSI).Methods: During a 26-month period, patients (n = 273) who stayed more than 6 days in the ICU of the University Hospital of Patras, Greece, were divided into 2 groups, those ...
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We evaluated the number of deaths attributable to carbapenem-resistant Enterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case–contro...
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#1George L. Daikos (UoA: National and Kapodistrian University of Athens)H-Index: 37
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Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs ...
297 CitationsSource
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#1Biying Zhang (Soochow University (Suzhou))
#2Zhichen Zhu (Soochow University (Suzhou))
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Abstract Objectives To study the molecular epidemiology of clinical MBL-Enterobacteriaceae isolates in China and to evaluate the antimicrobial susceptibility of aztreonam-avibactam against MBL-Enterobacteriaceae isolates. Methods Bacterial speciation was determined using the MALDI-TOF MS apparatus. PCR was used to screen common carbapenemase genes. Antimicrobial susceptibility testing of common clinical antibiotics and aztreonam-avibactam was performed by standard broth microdilution method. Res...
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