scholarly journals 1194. Carbapenem-Resistant Enterobacteriaceae in Kentucky: Initial 6 Months of Mechanism Testing

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S361-S361
Author(s):  
Kevin Spicer ◽  
Katelyn Cox ◽  
Rachel Zinner ◽  
Andrea Flinchum
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Demographic Data ◽  
Acute Care Hospital ◽  
The United States ◽  
Care Hospital ◽  
Local Data ◽  
Carbapenem Resistant ◽  
State And Local ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A global rise in carbapenem-resistant Enterobacteriaceae (CRE) has been noted over the past two decades. State and local data on CRE are necessary to better inform public health interventions. Methods Reporting of CRE (i.e., Enterobacteriaceae resistant to any carbapenem or shown to produce a carbapenemase) was mandated in Kentucky in 2015. Voluntary submission of isolates to the Antibiotic Resistance Laboratory Network regional laboratory for carbapenemase testing began September 2017. Demographic data collected as part of reporting included age, sex, county of residence, and inpatient/outpatient status. Descriptive and chi-square analyses were performed. Results Between September 1, 2017 and February 28, 2018, 149 CRE were reported to the Kentucky Department for Public Health. Testing for presence of a carbapenemase was performed on 115 isolates (77.2%); 44 (38.3%) were carbapenemase producing (CP)-CRE and Klebsiella pneumoniae carbapenemase (KPC) was identified from 38 (86.4%). Also identified were Verona integron-encoded metallo-β-lactamase (VIM; 5, 11.4%) and New Delhi metallo-β-lactamase (NDM; 1, 2.3%). Identification of carbapenemase varied among genera: Citrobacter (3/4, 75%), Klebsiella (21/40, 52.5%), Serratia (2/5, 40%), Escherichia (6/20, 30%), Enterobacter (11/41, 26.8%), Proteus (0/4, 0%), other genera (1/2, 50%). CRE isolates from urban or suburban areas were more likely CP-CRE than were those from rural areas (30/65, 46.2% vs. 14/50, 28%, P = 0.047). Carbapenemase was identified more often among CRE isolates from currently hospitalized patients than from patients whose cultures were collected outside of an acute care hospital (37/70, 52.8% vs. 7/45, 15.6%; P < 0.001). Conclusion The percentage of CRE that were CP-CRE in Kentucky was comparable with that reported for the United States (38 vs. 32%). Klebsiella spp., the genera historically associated with CP-CRE, made up less than half of CP-CRE. CP isolates were identified from urban, suburban, and rural settings and more frequently from isolates collected in hospitals compared with the community. The additional epidemiology obtained as part of this reporting system has identified metropolitan areas of the state as targets for CRE prevention efforts. Disclosures All authors: No reported disclosures.

scholarly journals Aggressive Colonization Screening and Infection Control Measures in Containment of NDM-5 Carbapenemase-Producing CRE

2020 ◽  
Vol 41 (S1) ◽  
pp. s458-s459
Author(s):  
Ishrat Kamal-Ahmed ◽  
Kate Tyner ◽  
Teresa Fitzgerald ◽  
Heather Adele Moulton-Meissner ◽  
Gillian McAllister ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
The United States ◽  
Control Measures ◽  
Care Hospital ◽  
Clinical Culture ◽  
Medical Histories ◽  
Asymptomatic Case

Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.Funding: NoneDisclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.

Carbapenem-Resistant Enterobacteriaceae Rectal Screening during an Outbreak of New Delhi Metallo-β-Lactamase–Producing Klebsiella pneumoniae at an Acute Care Hospital

2014 ◽  
Vol 35 (4) ◽  
pp. 434-436 ◽  
Author(s):  
Larissa M. Pisney ◽  
M. A. Barron ◽  
E. Kassner ◽  
D. Havens ◽  
N. E. Madinger
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Acute Care Hospital ◽  
University Teaching ◽  
New Delhi ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-β-lactamase–producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

scholarly journals Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India

2021 ◽  
Author(s):  
Chirag Manojkumar Modi ◽  
Suman Praveen Singh ◽  
Yagnesh Gajanand Pandya ◽  
Chirag Premjibhai Patel ◽  
Rupal Minesh Patel
Keyword(s):  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Treatment Options ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Defined Daily Dose ◽  
Sample Type ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiellasp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.

Much to Do about Carbapenem-Resistant Enterobacteriaceae: Why Supplementing Surveillance May Be the Key to Stopping Spread

2014 ◽  
Vol 35 (8) ◽  
pp. 984-986 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Zintars G. Beldavs
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Artery Bypass ◽  
Vital Signs ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Colon Surgery ◽  
The United States ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

(See the article by Thaden et al, on pages 978–983.)It is critical to the future of public health to understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) so that we can effectively target efforts to limit potential spread. The Centers for Disease Control and Prevention (CDC) classifies CRE as 1 of 3 “urgent” antibiotic resistance threats to public health because of the high mortality associated with CRE infection and its rapid dissemination in the United States.What is the current burden of CRE disease? We can glean a snapshot of the national epidemiology of CRE from the CDC’s national surveillance. Rapid geographic spread is evident in the CDC’s national map of CRE, which indicates that all but 3 states now have identified CRE. Incidence by facility type, procedure, device, and organism all have considerable variation, providing preliminary indications where future prevention efforts might best be focused. The 2013 CRE Vital Signs states that 3.9% of short-stay acute care hospitals and 17.8% of long-term acute care hospitals have identified cases of CRE infection among those with catheter-associated urinary tract infection (CAUTI) or central line–associated bloodstream infection (CLABSI). The CDC also reported that 10% of Klebsiella species in intensive care unit (ICU) CLABSIs, ICU CAUTIs, and surgical site infections after colon surgery or coronary artery bypass grafting in 2011 were carbapenem resistant. Although CRE have been reported in most states, it is increasingly clear that wide regional variation exists, from regions of hyperendemicity, such as parts of New York City, to regions apparently free of CRE, such as Maine.

scholarly journals Carbapenemase Gene Profiles in Carbapenem-Resistant Enterobacteriaceae—United States, January 2018–August 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s149-s150
Author(s):  
Jennifer Huang ◽  
Amanda Pettinger ◽  
Katie Bantle ◽  
Amelia Bhatnagar ◽  
Sarah Gilbert ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Drug Combination ◽  
The United States ◽  
Molecular Testing ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Gene Profiles ◽  
Carbapenemase Gene ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality each year in the United States. Treatment options for these infections are often limited, in part due to carbapenemases, which are mobile β-lactam-hydrolyzing enzymes that confer multidrug resistance in CRE. As part of the CDC’s Containment Strategy for Emerging Resistance, public health laboratories (PHLs) in the CDC Antibiotic Resistance Laboratory Network (AR Lab Network) have worked to characterize clinical isolates of CRE for rapid identification of carbapenemase genes. These data are then used by public health and healthcare partners to promote patient safety by decreasing the spread of resistance. We summarize carbapenemase gene profiles in CRE, by genus and geography, using data collected through the AR Lab Network from January 2018 through August 2019. Methods: CRE isolates were submitted to 55 PHLs, including those of all 50 states, 4 large cities, and Puerto Rico, in accordance with each jurisdiction’s reporting laws. PHLs performed phenotypic and molecular testing on isolates to detect targeted, emerging carbapenemase genes and reported results to submitters. Carbapenemase-positive (CP) isolates were defined as PCR positive for ≥1 carbapenemase gene tested: blaKPC, blaNDM, blaVIM, blaIMP, blaOXA-48–LIKE. PHLs submitted results to CDC monthly. Genera other than Enterobacter, Klebsiella, and Escherichia coli are categorized as other genera in this analysis. Data were compiled and analyzed using SAS v 9.4 software. Results: From January 2018 to August 2019, the AR Lab Network tested 25,705 CRE isolates; 8,864 of 25,705 CRE (34%) were CP. Klebsiella spp represented the largest proportion of CP-CRE at 68% (n = 6,063), followed by E. coli (12%, n = 1,052), Enterobacter spp (11%, n = 981), and other genera (9%, n = 768). Figure 1a shows the composition of CP-CRE carbapenemase genes by genus. The most common carbapenemase and genus profiles were blaKPC in Klebsiella (74%; 5,562 of 7,561 blaKPC-positive) blaNDM in E. coli (43%; 372 of 868 blaNDM-positive) blaVIM in Enterobacter spp (35%; 25 of 72 blaVIM-positive), and blaIMP among other genera (90%; 92 of 102 blaIMP-positive). Common CP-CRE genes and genera also varied by geography (Fig. 1b). Conclusions: The AR Lab Network has greatly enhanced our nation’s ability to detect and characterize CP-CRE. Our data provide a snapshot of the organisms and regions where mobile carbapenemase genes are most often detected in CRE. Geographic variation in CP gene profiles provides actionable data to inform local priorities for detection and infection control and provide clinicians with situational awareness of the genes and organisms that are circulating in their region.Funding: NoneDisclosures: In this presentation, the authors discuss the drug combination aztreonam-avibactam and acknowledge that this drug combination is not currently FDA-approved.

scholarly journals Wide Range of Carbapenem-resistant Enterobacteriaceae Incidence and Trends in Emerging Infections Program Surveillance, 2012–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S50-S50
Author(s):  
Nadezhda Duffy ◽  
Cedric J Brown ◽  
Sandra N Bulens ◽  
Wendy Bamberg ◽  
Sarah J Janelle ◽  
...  
Keyword(s):  
The United States ◽  
Effective Control ◽  
High Morbidity ◽  
Care Hospital ◽  
Emerging Infections ◽  
Term Care ◽  
Carbapenem Resistant ◽  
Wide Range ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat in the United States because of high morbidity and mortality, few treatment options, and potential for rapid spread among patients. To assess for changes in CRE epidemiology and risk among populations, we analyzed CDC Emerging Infections Program (EIP) 2012–2015 surveillance data for CRE. Methods Active, population-based CRE surveillance was initiated in January 2012 at 3 EIP sites (GA, MN, OR) and expanded to 5 additional sites (CO, MD, NM, New York, TN) by 2014. An incident case was the first Escherichia coli, Enterobacter, or Klebsiella isolate (non-susceptible to at least one carbapenem and resistant to all third-generation cephalosporins tested) collected from urine or a normally sterile body site from a patient during a 30-day period. Data were collected from patients’ medical records. Cases were hospital-onset (HO) or long-term care facility (LTCF) onset if patients were in the respective facility ≥3 days prior to culture or at the time of culture; and community-onset (CO) otherwise. We calculated incidence rates based on census data for EIP sites and described by type of infection onset. Results A total of 1,582 incident CRE cases were reported in 2012–2015. Most cases (88%) were identified through urine cultures; 946 (60%) were female, and median age was 66 years (interquartile range: 55–77). The median incidence by site was 2.95 per 100,000 population (range: 0.35–8.98). Among the three sites with four full years of data, a different trend was seen in each (Figure). Trends in GA and MN were statistically significant, and no significant trend was seen in OR. Overall, 480 cases (30%) were HO, 524 (33%) were LTCF onset, and 578 (37%) were CO. Of CO cases, 308 (53%) had been hospitalized, admitted to a long- term acute care hospital or were a LTCF resident in the prior year. Conclusion CRE incidence varied more than 20-fold across surveillance sites, with evidence of continued increases in MN. Measuring impact of programs aimed at reducing CRE transmission in other regions will require obtaining local data to identify cases occurring during and after healthcare facility discharge. Further study of changes in incidence in some settings and areas might offer opportunities to refine and expand effective control strategies. Disclosures All authors: No reported disclosures.

scholarly journals Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

2012 ◽  
Vol 33 (10) ◽  
pp. 984-992 ◽  
Author(s):  
Amit S. Chitnis ◽  
Pam S. Caruthers ◽  
Agam K. Rao ◽  
JoAnne Lamb ◽  
Robert Lurvey ◽  
...  
Keyword(s):  
Acute Care ◽  
Genetic Relatedness ◽  
Acute Care Hospital ◽  
Public Health Approach ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Targeted Interventions ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.Design, Setting, and Patients.Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).Methods.Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.Results.Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.Conclusion.CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.Infect Control Hosp Epidemiol 2012;33(10):984-992

Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-β-Lactamase at an Acute Care Hospital, Colorado, 2012

2014 ◽  
Vol 35 (4) ◽  
pp. 390-397 ◽  
Author(s):  
Erin E. Epson ◽  
Larissa M. Pisney ◽  
Joyanna M. Wendt ◽  
Duncan R. MacCannell ◽  
Sarah J. Janelle ◽  
...  
Keyword(s):  
Acute Care ◽  
Medical Records ◽  
Acute Care Hospital ◽  
New Delhi ◽  
Care Hospital ◽  
Hospital Units ◽  
Direct Observations ◽  
Carbapenem Resistant ◽  
Polymerase Chain ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission.Design, Setting, and Patients.Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital.Methods.Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations.Results.Two patients were initially identified with NDM-producing CRE during July–August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission.Conclusions.A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.

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