scholarly journals Trends in community- and nosocomial-acquired infections of carbapenem resistant Enterobacteriaceae (CRE), carbapenemase producing Enterobacteriaceae (CPE) and vancomycin resistant Enterococcus (VRE): a 10-year prospective observational study

2021 ◽  
Author(s):  
Gloria Maritza Ubillus Arriola ◽  
William Araujo Banchon ◽  
Lilian Patiño Gabriel ◽  
Lenka Kolevic ◽  
María del Carmen Quispe Manco ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Vancomycin Resistant Enterococcus ◽  
Interventional Study ◽  
Carbapenem Resistant ◽  
Infection Pattern ◽  
Increasing Trend ◽  
Vancomycin Resistant ◽  
Increasing Trends ◽  
Community Onset ◽  
Carbapenem Resistant Enterobacteriaceae

AbstractIntroductionCRE, CPE, and VRE are considered significant threats to public health.AimTo determine trends of nosocomial- and community-acquired infections.MethodsA 10-year prospective observational non-interventional study was conducted. We used time-series analysis to evaluate trends in infections number.FindingsInfection rate (%) were: CRE 2.48 (261/10,533), CPE 1.66 (175/10,533) and VRE 15.9 (121/761). We found diminishing trends for CRE (−19% [−31;−5], P=.03) and CPE (−22% [−30;−8], P=.04) but increasing trend for VRE (+48; [CI95% 34;75], P=.001). While we found decreasing trends for CRE and CPE in emergency (−71 [−122;−25], P=.001; −45 [−92;−27], P=.001) and hospitalization (−127 [−159; −85], P=.001; −56 [−98;−216], P=.01), we found increasing trends for VRE (+148 [113;192], P=.00001; +108[65;152], P=.003). Nosocomial-infections fell in CRE (−238 [−183;−316], P=.0001) and CPE (−163 [−96; −208], P=.001), but rose in VRE (+196 [151;242], P=.0001). We showed increasing trends in ambulatory and community-acquired infections in CRE (+134% [96;189]; P=.001; +77% [52;89]; P= .002), CPE (+288 [226;343]; P=.0001; +21% [−12;46]; P=.0.08) and VRE (+348 [295;458]; P=.0001; +66% [41;83]; P=.003). Direct admitted trends rose in all groups (CRE 16% [−8; 42]; P=.05), CPE 23% [−6; 48] (P=.05) and VRE (+241 [188; 301]; P=.0001).ConclusionsWe found a changing infection pattern with decreasing trends in in-hospital settings and nosocomial-acquired infections but increasing ambulatory and community-acquired infections. The observed increasing-trends in direct-admitted could be explained by community-onset infections diagnosed in the hospital. Our findings highlight the need to identify CRE/CPE/VRE community-acquired infections in ambulatory and in-hospital settings.

scholarly journals Fosfomycin activity versus carbapenem-resistant Enterobacteriaceae and vancomycin-resistant Enterococcus, Detroit, 2008–10

2013 ◽  
Vol 66 (10) ◽  
pp. 625-627 ◽  
Author(s):  
Jason M Pogue ◽  
Dror Marchaim ◽  
Odaliz Abreu-Lanfranco ◽  
Bharath Sunkara ◽  
Ryan P Mynatt ◽  
...  
Keyword(s):  
Vancomycin Resistant Enterococcus ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals 563. Association Between Chlorhexidine Gluconate Concentrations and Resistant Bacterial Bioburden on Skin

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S267-S267
Author(s):  
Gita Nadimpalli ◽  
Lyndsay M O’Hara ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
Natalia Blanco ◽  
...  
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Chlorhexidine Gluconate ◽  
Bacterial Burden ◽  
Positive Correlation ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
The Mean ◽  
Vancomycin Resistant ◽  
Spearman’S Correlation ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Little research exists to guide optimal Chlorhexidine gluconate (CHG) bathing practices. We examined the association between CHG concentrations and methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococcus (VRE) on the skin. Also, we studied whether bioburden is affected by bathing method (2% CHG cloth vs. 4% liquid CHG soap) and time since last CHG bath. Methods Patients with MRSA, CRE and VRE at 4 US hospitals were enrolled. Skin swabs (arm, chest) were collected to quantify bioburden and CHG concentrations. Information on bathing method and time since last CHG bath was collected. χ 2 test, Spearman’s correlation, and linear regression were performed. Results 253 patients were enrolled. On arm skin, MRSA was detected in 17 (19%), CRE on 16 (12%), and VRE on 12 (21%) patients. Detectable CHG levels were observed in 82 (93%) MRSA, 81 (79%) CRE, and 44 (79%) VRE patients. A negative correlation was observed between bioburden and CHG concentration for MRSA (rs = −0.11, P = 0.28) and CRE (rs = −0.02, P = 0.82) while a positive correlation was observed for VRE (rs = 0.15, P = 0.28). On chest skin, MRSA was detected in 25 (28%), CRE on 18 (12%), and VRE on 7 (13%) patients. Detectable CHG levels were observed in 83 (95.4%) MRSA, 78 (72%) CRE, and 43 (77%) VRE patients. MRSA bioburden was negatively correlated with CHG concentration (rs = −0.16, P = 0.12), while a positive correlation was noted for CRE (rs = 0.18, P = 0.06) and VRE (rs =0.24, P = 0.06). There was no significant difference in bacterial bioburden between CHG concentrations (>20 ppm vs. ≤20 ppm) at both skin sites (Table 1). The bioburden did not differ by method of CHG bath. The mean estimates of bacterial bioburden on both skin sites did not show a significant decrease with increase in CHG concentrations and were not affected by time since last bath (Table 2). Conclusion Detection of MRSA, CRE and VRE was infrequent irrespective of CHG bathing method and time since last bath. We found inconsistent associations between increasing CHG concentrations and bacterial bioburden. CHG bathing frequency may be optimized for individual patient populations to augment the reduction of bacteria. Additional research to understand the association of CHG skin concentrations and resistant bacterial burden is required. Disclosures All authors: No reported disclosures.

scholarly journals Clinical and Microbiological Characteristics of Community-Onset Carbapenem-Resistant Enterobacteriaceae Isolates

2020 ◽  
Vol Volume 13 ◽  
pp. 3131-3143
Author(s):  
Hangbin Hu ◽  
Jinchao Mao ◽  
Yiyi Chen ◽  
Jie Wang ◽  
Piaopiao Zhang ◽  
...  
Keyword(s):  
Carbapenem Resistant ◽  
Microbiological Characteristics ◽  
Community Onset ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals 737. Novel Glycans Reduce Carbapenem-Resistant Enterobacteriaceae and Vancomycin-Resistant Enterococci Colonization in an Ex Vivo Assay by Supporting Growth and Diversity of Commensal Microbiota at the Expense of MultiDrug-Resistant Organisms (MDRO)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S330-S330
Author(s):  
Gabby LeBlanc ◽  
Brandon Brooks ◽  
Madeline Hartman ◽  
Maxwell B Hecht ◽  
Hoa Luong ◽  
...  
Keyword(s):  
Critically Ill ◽  
Ex Vivo ◽  
Metagenomic Sequencing ◽  
Clinical Infection ◽  
Commensal Microbiota ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Infections with Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococci (VRE) can result in a 50% mortality rate in compromised hosts. A major risk factor for clinical infection is intestinal colonization with CRE or VRE. There are currently no FDA-approved compounds to decolonize these organisms from the gastrointestinal tract (gut). Commensal microbes offer protection from pathogen infection; however, in immunocompromised hosts or with antibiotic treatment, the protective properties of the microbial community are compromised, leaving the gut susceptible to pathogen colonization. Higher concentrations of pathogens within the gut correlate with an increased risk of infection with MDROs. Our hypothesis is that reducing colonization of the gut with MDROs would reduce the likelihood of a clinical infection. Methods Kaleido built a platform that emulates the gut environment and allows for high throughput screening of Kaleido’s Microbiome Metabolic Therapies (MMT™) in human gut microbiomes ex vivo. Over 500 compounds were screened for their ability to reduce the levels of CRE and VRE in fecal microbial communities from both healthy subjects and critically ill patients receiving broad-spectrum antibiotics. Results Kaleido’s lead MMTs selectively favor the growth of the commensal microbiota at the expense of pathogens, resulting in a decrease of CRE and VRE from 80% of the initial community to 5% in a single batch culture, as measured by 16S rRNA gene and shotgun metagenomic sequencing. Lead MMTs do not support growth of CRE and VRE strains in culture, nor of other pathogens frequently encountered in critically ill and immunocompromised patients, such as Clostridium difficile and common fungal pathogens. Conclusion These results suggest that intervention with MMTs may reduce CRE and VRE colonization and support further evaluation in patients colonized with CRE or VRE pathogens. Disclosures All authors: No reported disclosures.

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