Clinical management of severe infections caused by carbapenem-resistant Gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations

Objective. Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization. Methodology. A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal. Results. A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar. Conclusions. The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization.

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The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria: A Prospective Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy371 ◽

2018 ◽

Cited By ~ 2

Author(s):

Yael Zak-Doron ◽

Yael Dishon Benattar ◽

Iris Pfeffer ◽

George L Daikos ◽

Anna Skiada ◽

...

Keyword(s):

Prospective Study ◽

Antibiotic Treatment ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Empirical Antibiotic Treatment ◽

Carbapenem Resistant ◽

Severe Infections ◽

A Prospective Study

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Variation in Definitions and Isolation Procedures for Multidrug-Resistant Gram-Negative Bacteria: A Survey of the Society for Healthcare Epidemiology of America Research Network

Infection Control and Hospital Epidemiology ◽

10.1086/675600 ◽

2014 ◽

Vol 35 (4) ◽

pp. 362-366 ◽

Cited By ~ 23

Author(s):

Marci Drees ◽

Lisa Pineles ◽

Anthony D. Harris ◽

Daniel J. Morgan

Keyword(s):

Infection Control ◽

Online Survey ◽

Multidrug Resistant ◽

Research Network ◽

Gram Negative Bacteria ◽

Emerging Pathogens ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Gram Negative ◽

Healthcare Epidemiology

Objective.To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.Design.Cross-sectional survey.Participants.US and international members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.Methods.Online survey that included definitions, infection control procedures, and microbiology capability related to MDR-GNB and other MDR bacteria.Results.From November 2012 through February 2013, 66 of 170 SHEA Research Network members responded (39% response rate), representing 26 states and 15 countries. More than 80% of facilities reported experience with each MDR-GNB isolate, and 78% had encountered GNB resistant to all antibiotics except colistin (62% Acinetobacter, 59% Pseudomonas, and 52% Enterobacteriaceae species). Participants varied regarding their definitions of “multidrug resistant,” with 14 unique definitions for Acinetobacter, 18 for Pseudomonas, and 22 for Enterobacteriaceae species. Substantial variation also existed in isolation practices. Although isolation was commonly used for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE), approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter. The majority of those that isolated MDR organisms also removed isolation using a wide variety of criteria.Conclusion.Facilities vary significantly in their approach to preventing MDR-GNB transmission. Although practices for MRSA and VRE are relatively standardized, emerging pathogens CRE and other MDR-GNB have highly varied definitions and management. This confusion makes communication difficult, and varied use of isolation may contribute to emergence of these organisms. Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of MDR-GNB.

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