scholarly journals 496. Carbapenem-resistant Enterobacter: A Case-Case–Control Investigation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S242-S242
Author(s):  
Leore Cohen Mendel ◽  
David Katz ◽  
Tsilia Lazarovitch ◽  
Ronit Zaidenstein ◽  
Dror Marchaim
Keyword(s):  
Cox Regression ◽  
Clinical Epidemiology ◽  
Medical Center ◽  
Care Facility ◽  
Case Control ◽  
World Health ◽  
Term Care ◽  
Long Term Care Facility ◽  
Carbapenem Resistant ◽  
Matched Design

Abstract Background. Background The World Health Organization has declared carbapenem-resistant Enterobacteriaceae (CRE) as a worldwide public health threat. Analyzing the epidemiology of CRE was derived from cohorts consisting primarily of Klebsiella pneumoniae isolates. The second most frequent CRE is Enterobacter (CREn), but its molecular and clinical epidemiology differ from that of K. pneumoniae, and it has not been analyzed while implementing updated methodological tools and design. Methods A matched case-case–control investigation was conducted at Shamir (Assaf Harofeh) Medical Center, Israel, for calendar years 2007–2017. Each CREn case was matched to a carbapenem-susceptible Enterobacter (CSEn) case and to an uninfected control (1:1:1 ratio). Logistic and Cox regression-matched analyses were conducted in order to study predictors and outcomes of CREn colonization and/or infection, respectively. Results The study included 216 cases (72 in each group). Numerous predictors were significantly associated with CREn as per bivariable analyses, but the only independent significant predictors were: (1) recent (3 months) exposure to fluoroquinolones (aOR=2.94, P = 0.04), (2) intensive care unit stay in current hospitalization prior to culture (aOR=3.56, P = 0.003), and (3) a rapidly fatal McCabe score (aOR=0.471, P = 0.01). Patients with CREn suffered from significant delays in instituting appropriate antimicrobials (P = 0.03), and for those who survived the hospitalization, were more frequently discharged to a long-term care facility after being admitted to the index hospitalization from home (aOR=3.3, P = 0.02). Conclusion This case-case–control-matched investigation of CREn epidemiology, revealed a unique modifiable predictor, i.e., recent fluoroquinolone exposure, which could represent a target for stewardship intervention. The case-case–control-matched design allowed for the control of numerous confounders previously reported to be associated with CREn but may represent a risk factor for Enterobacter infection in general. As with other CRE, CREn carriers suffer from significant delays in initiation of appropriate antimicrobials and from worse outcomes. Disclosures All authors: No reported disclosures.

The epidemiology of carbapenem resistant Enterobacter spp: A case–case–control matched analysis

2020 ◽  
pp. 1-6
Author(s):  
Leore Cohen Mendel ◽  
Keren Amity ◽  
David E. Katz ◽  
Tsilia Lazarovitch ◽  
Ronit Zaidenstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Long Term Care ◽  
Care Facility ◽  
Case Control ◽  
Term Care ◽  
Long Term Care Facility ◽  
Recent Exposure ◽  
Carbapenem Resistant

Abstract A case–case–control investigation (216 patients) examined the risk factors and outcomes of carbapenem-resistant Enterobacter (CR-En) acquisition. Recent exposure to fluoroquinolones, intensive care unit (ICU) stay, and rapidly fatal McCabe condition were independent predictors for acquisition. Acquiring CR-En was independently associated with discharge to a long-term care facility after being admitted from home.

Clostridium difficile Infection in a Department of Veterans Affairs Long-Term Care Facility

2011 ◽  
Vol 32 (5) ◽  
pp. 513-515 ◽  
Author(s):  
Dubert M. Guerrero ◽  
Michelle M. Nerandzic ◽  
Lucy A. Jury ◽  
Shelley Chang ◽  
Robin L. Jump ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Medical Center ◽  
Care Facility ◽  
Healthcare Facility ◽  
Veterans Affairs ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.

Limiting the Emergence of Extended-Spectrumβ–Lactamase-Producing Enterobacteriaceae: Influence of Patient Population Characteristics on the Response to Antimicrobial Formulary Interventions

2006 ◽  
Vol 27 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Adam D. Lipworth ◽  
Emily P. Hyle ◽  
Neil O. Fishman ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Facility ◽  
Decubitus Ulcer ◽  
Population Characteristics ◽  
Term Care ◽  
Long Term Care Facility

Background.Effective methods to control the emergence of extended-spectrumβ-lactamase-producingEscherichia coliandKlebsiellaspecies (ESBL-EK) remain unclear. Variations in the patient populations at different hospitals may influence the effect of antimicrobial formulary interventions.Methods.To examine variations across hospitals in the response to antimicrobial interventions (ie, restriction of ceftazidime and ceftriaxone) designed to curb the spread of ESBL-EK, we conducted a 5-year quasi-experimental study. This study was conducted at 2 hospitals within the same health system: Hospital A is a 625-bed academic medical center, and Hospital B is a 344-bed urban community hospital. All adult patients with a healthcare-acquired clinical culture of ESBL-EK from July 1, 1997 through December 31, 2002 were included.Results.After the interventions, the use of ceftriaxone decreased by 86% at Hospital A and by 95% at Hospital B, whereas the use of ceftazidime decreased by 95% at Hospital A and by 97% at Hospital B. The prevalence of ESBL-EK at Hospital A decreased by 45% (P< .001), compared with a 22% decrease at Hospital B (P= .36). The following variables were significantly more common among ESBL-EK-infected patients at Hospital B: residence in a long-term care facility (adjusted odds ratio, 3.77 [95% confidence interval, 1.70-8.37]), advanced age (adjusted odds ratio, 1.04 [95% confidence interval, 1.01-1.06]), and presence of a decubitus ulcer (adjusted odds ratio, 4.13 [95% confidence interval, 1.97-8.65]).Conclusions.The effect of antimicrobial formulary interventions intended to curb emergence of ESBL-EK may differ substantially across institutions, perhaps as a result of differences in patient populations. Variability in the epidemiological profiles of ESBL-EK isolates at different hospitals must be considered when designing interventions to respond to these pathogens.

Comparison between IMP carbapenemase-producing Enterobacteriaceae and non-carbapenemase-producing Enterobacteriaceae: a multicentre prospective study of the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae

2019 ◽  
Vol 75 (3) ◽  
pp. 697-708
Author(s):  
Kayoko Hayakawa ◽  
Ryuichi Nakano ◽  
Ryota Hase ◽  
Michitsugu Shimatani ◽  
Hideaki Kato ◽  
...  
Keyword(s):  
Care Facility ◽  
Length Of Hospital Stay ◽  
Weighting Method ◽  
Term Care ◽  
Long Term Care Facility ◽  
Carbapenem Resistant ◽  
Public Health Reporting ◽  
Hospital Stays ◽  
Prolonged Hospital ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase. Objectives We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE. Methods Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis. Results Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group. Conclusions IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE.

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

2015 ◽  
Vol 53 (9) ◽  
pp. 2823-2826 ◽  
Author(s):  
Vincent J. LaBombardi ◽  
Carl M. Urban ◽  
Barry N. Kreiswirth ◽  
Liang Chen ◽  
Giuliana Osorio ◽  
...  
Keyword(s):  
Long Term Care ◽  
Agar Plate ◽  
Care Facility ◽  
Resistant Bacteria ◽  
Term Care ◽  
Content Type ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Carbapenem Resistant

We compared the Remel Spectra CRE agar plate to CDC standard methodology for the isolation of carbapenem-resistantEnterobacteriaceae(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 specificKlebsiella pneumoniaecarbapenemases (KPC) and additional β-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.

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