scholarly journals 2430. Impact of USCAST Proposed Breakpoint Changes to Aminoglycosides, Cyclines, and Levofloxacin on Carbapenem-Resistant Enterobacteriaceae at a US Tertiary Referral Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S726-S727 ◽  
Author(s):  
Brandon Kulengowski ◽  
Gretchen Ingling ◽  
Kristen E Wilhite ◽  
David S Burgess
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Referral ◽  
Carbapenem Resistant ◽  
Academic Medical ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Difference in Susceptibility Between Carbapenemase- and Non–Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae

2021 ◽  
Vol 1 (S1) ◽  
pp. s70-s70
Author(s):  
Justin Clark ◽  
David Burgess
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Automated System ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Academic Medical ◽  
Break Points ◽  
Susceptibility Profiles ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) remain among the most urgent infectious threats according to the CDC Threats Reports. Although focus has often been placed on carbapenemase-producing phenotypes, there is increasing interest in distinguishing the optimal treatment and outcomes of carbapenemase-producing (CP) and non–carbapenemase-producing (NCP) CRE. We compare antimicrobial susceptibility patterns between CP-CRE and NCP-CRE isolated from patients at our academic medical center. Methods: All CRE isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, and K. pneumoniae in adult inpatients from 2010 to 2019 were included in this study. Susceptibility testing was performed using the BD Phoenix Automated System (BD Diagnostics, Sparks, MD). CLSI susceptibility break points were utilized in the susceptibility analyses of all antimicrobials tested. To determine carbapenemase production, isolates resistant only to ertapenem were considered NCP-CRE, and those resistant to both ertapenem and meropenem were considered CP-CRE. Statistical comparisons of susceptibility profiles were performed using either the χ2 test or the Fisher exact test. All data preprocessing and statistical analyses were performed using Python software. Results: Over the decade, we identified 291 CRE isolates (216 isolates resistant only to ertapenem and 75 resistant to ertapenem and meropenem). The ertapenem-resistant–only phenotype comprises ~66% of the total CRE population and is largely composed of E. cloacae (67%). As expected, most β-lactam susceptibilities were negligibly low between the 2 groups; however, other clinically relevant antimicrobials (aminoglycosides, fluoroquinolones, and sulfamethoxazole/trimethoprim) exhibited starkly different susceptibility profiles (P value Conclusions: These findings suggest that the most predominant CRE phenotype at our institution is not carbapenemase production. Evaluation of outcomes between CP- and NCP-CRE should be pursued further. The large differences in the MIC distributions may lead to differing outcomes for the affected patients.Funding: NoDisclosures: None

Imipenem/relebactam activity compared to other antimicrobials against non-MBL-producing carbapenem-resistant Enterobacteriaceae from an academic medical center

2019 ◽  
Vol 77 (4) ◽  
Author(s):  
Brandon Kulengowski ◽  
David S Burgess
Keyword(s):  
Antimicrobial Agents ◽  
Medical Center ◽  
Phenylboronic Acid ◽  
Academic Medical Center ◽  
Clinical Isolates ◽  
Beta Lactamase ◽  
In Vitro Susceptibility ◽  
Carbapenem Resistant ◽  
Academic Medical ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACTBackgroundCarbapenem-resistant Enterobacteriaceae (CRE) cause significant mortality and are resistant to most antimicrobial agents. Imipenem/relebactam, a novel beta-lactam/beta-lactamase inhibitor combination, and 16 other antimicrobials were evaluated against non-metallo-beta-lactamase-producing carbapenem-resistant Enterobacteriaceae clinical isolates from a United States tertiary academic medical center.ObjectivesTo evaluate imipenem/relebactam and other commonly utilised antimicrobial agents against carbapenem-resistant Enterobacteriaceae. Methods: Clinical isolates (n  = 96) resistant to ertapenem or meropenem by BD Phoenix (Becton, Dickinson and Company, Franklin Lakes, NJ, USA) and negative for metallo-beta-lactamase-production by an EDTA (Sigma-Aldrich Corp., St. Louis, MO, USA)/phenylboronic acid (Sigma-Aldrich Corp., St. Louis, MO, USA) disk diffusion assay were identified and collected from January 2012 to January 2017. In vitro susceptibility by broth microdilution was performed according to CLSI guidelines using CLSI susceptibility breakpoints for 17 antimicrobials (Sigma-Aldrich Corp., St. Louis, MO, USA).ResultsCRE primarily produced Klebsiella pneumoniae carbapenemase (KPC) and consisted primarily of K. pneumoniae (55%) and Enterobacter spp. (25%), followed by Citrobacter spp. (10%), Escherichia coli (5%), and others (5%). CRE were most susceptible to imipenem/relebactam (100%), followed by amikacin (85%), tigecycline (82%), and polymyxin B/colistin (65%). The median reduction of imipenem minimum inhibitory concentrations (MICs) of non-MBL-producing CRE was 16-fold but ranged from 0.5 to >512-fold. The MIC50, MIC90 and MIC range of imipenem/relebactam was 0.5/4, 1/4 and 0.06/4–1/4 mg/L, respectively.ConclusionsImipenem/relebactam exhibits excellent activity against CRE that produce KPC.

scholarly journals Tu1925 – Revisional Bariatric Surgery At a Single Institution: Results from a New Tertiary Referral Academic Medical Center in the Middle East

2019 ◽  
Vol 156 (6) ◽  
pp. S-1504
Author(s):  
Juan S. Barajas-Gamboa ◽  
Ricard Corcelles ◽  
Joshua P. Landreneau ◽  
Carlos Abril ◽  
Andrew T. Strong ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Middle East ◽  
Medical Center ◽  
Academic Medical Center ◽  
Revisional Bariatric Surgery ◽  
Single Institution ◽  
Tertiary Referral ◽  
Academic Medical

Epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae colonisation and infections: case-controlled study from an academic medical center in a southern area of China

2019 ◽  
Vol 77 (4) ◽  
Author(s):  
Lili Fang ◽  
Xiaohui Lu ◽  
Heping Xu ◽  
Xiaobo Ma ◽  
Yilan Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pulmonary Diseases ◽  
Controlled Study ◽  
Global Public Health ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Associated Risk Factors ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT OBJECTIVE While the emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) and related infections pose serious threats to global public health, the epidemiology and associated risk factors remain poorly understood and vary by geography. METHODS In a case-controlled retrospective study, we examined the prevalence, patient background and risk factors for CRE colonisation and infections, and all patient-derived CRE from January 2015 to January 2017. Isolated carbapenem-susceptible Enterobacteriaceae (CSE) from 2875 enrolled patients were randomly selected during the study. RESULTS CRE colonisation and infections detection rates were 47/2875 (1.6%). Respiratory tract specimens were most frequently seen in 20/47 (42.6%) cases. Klebsiella pneumoniae was the main isolate in 35/47 (74.5%) CRE. As for carbapenemase, KPC-2-producing bacteria was most frequently detected in 38/47 (80.9%) Enterobacteriaceae. No underlying conditions (P = 0.004), pulmonary diseases (P = 0.018) and no antibiotics used prior to culture within 30 days (P < 0.001) were statistically significant between the CRE and CSE groups. CONCLUSION Klebsiellapneumoniae was the main isolate of CRE. The blaKPC-2 was the predominant CRE gene. Underlying conditions especially pulmonary diseases and antibiotics used prior to culture within 30 days represented key risk factors for acquisition of CRE.

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