scholarly journals Multidrug-resistant Gram-negative bacteria from patients, hospital environment and healthcare workers: a six-month cross-sectional study

2018 ◽  
Author(s):  
Aline F. R. Sereia ◽  
Patricia A. da Cunha ◽  
Daniela C. Tartari ◽  
Caetana P. Zamparette ◽  
Diana A. Estigarribia ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Surveillance Program ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Hospital Units

AbstractHealthcare-associated infections (HAI) are an important public health threat with the multidrug-resistant (MDR) gram-negative bacteria (GNB) being of particular concern. Here we present the antimicrobial resistance profile of HAI-related GNB (HAIrB) isolated from patients (PT), healthcare workers (HCW) and hospital environment (HE) in a six-month screening program. From the 180 sampling points distributed in six hospital units, a total of 1,080 swabs were collected allowing the isolation of 390 HAIrB: 50.5% from HE, 42.6% from PT and 6.9% from HCW. Among the HAIrB, 32.6% were characterized as MDR and 38.7% as extended-spectrum cephalosporins resistant (ESC-R), showing no differences in the distribution between PT, HE and HCW. Carbapenem resistance (CARB-R) was detected for 17.7% of all HAIrB, being higher among Acinetobacter spp. isolates (36.5%), followed by Enterobacteriaceae (14.5%) and Pseudomonas spp. (11.8%). Except for the ICU, that revealed higher MDR, CARB-R and ESC-R rates, HAIrB-resistant profiles were similarly detected within the hospital units. Prevalence of blaKPC-like and blaCTX-M-1 β-lactamases-resistance genes was higher in K. pneumoniae and E. cloacae complex, while blaOXA-23-like and blaSPM-like were higher in A. baumannii and P. aeruginosa, respectively. This study reveals that the spreading of HAIrB within a hospital environment is higher than predicted, indicating that healthcare workers, hospital areas and equipment are key players on dissemination of MDR gram-negative bacteria and shows that an active surveillance program can provide precise understanding and direct actions towards control of HAI.

scholarly journals High Prevalence of Antimicrobial Resistance among Gram Negative Bacteria Isolated from Poultry

10.3823/824 ◽  
2018 ◽  
Vol 8 (3) ◽  
Author(s):  
Abdelraouf A Elmanama ◽  
Mariam Raed Al-Reefi ◽  
Mohammed A. Albayoumi ◽  
Alaa M. Marouf ◽  
Islam F. Hassona
Keyword(s):  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Health Concern ◽  
Resistance Pattern ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Salmonella Spp ◽  
Isolation And Identification ◽  
Gram Negative

Background: Multidrug resistant bacteria (MDR), such as Escherichia coli and Salmonella spp. are threat to the human health care system. In recent years, these MDR bacteria have been found increasingly inside and outside the hospital environment. Food animals (meat and poultry) are increasingly colonized with MDR bacteria, thus posing an additional concern. This study is intended to determine susceptibility and resistance pattern of pathogenic Gram negative bacteria isolated from rectal swabs of chicken against 16 antibiotics. Methods: A total of 216 cloacal swab samples (Gaza strip poultry farms) and 87 frozen and fresh meat samples (from slaughter houses and retails) from June 2017 to June 2018 were collected. Isolation and identification of organisms were achieved using standard bacteriological techniques. Antimicrobial susceptibility test was performed according to standard protocols. Results: 360 Enterobacteriaceae isolates, and 56 Gram-negative non fermenter were recovered. The predominant Enterobacteriaceae isolate was Citrobacter spp. (22.6%), followed by Enterobacter spp. (17.6%) and E. coli (16.5%). High rates of resistance against Ampicillin (85.4%) and Trimethoprim/ Sulfamethoxazole (80.1%) followed by Chloramphenicol (74%) were recorded. Six samples were positive for Salmonella spp. and Shigella spp. Of the tested Enterobacteriacae isolates, 94.7% were multidrug resistant (MDR), and 31.4% of  None fermenting bacilli (NFB) were MDR. Carbapenem resistance was found to be high among isolates; 51.9% for imipenem and 1.8% for meropenem. Conclusion: Isolated bacteria in the study area were MDR and this suggests that chickens may be important reservoir of antimicrobial resistant organisms which is a major public health concern.    

scholarly journals Species Diversity of Environmental GIM-1-Producing Bacteria Collected during a Long-Term Outbreak

2016 ◽  
Vol 82 (12) ◽  
pp. 3605-3610 ◽  
Author(s):  
Andreas F. Wendel ◽  
Sofija Ressina ◽  
Susanne Kolbe-Busch ◽  
Klaus Pfeffer ◽  
Colin R. MacKenzie
Keyword(s):  
Resistance Genes ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Resistant Bacteria ◽  
Environmental Sampling ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Content Type

ABSTRACTReports of outbreaks concerning carbapenemase-producing Gram-negative bacteria in which the main source of transmission is the hospital environment are increasing. This study describes the results of environmental sampling in a protracted polyspecies metallo-beta-lactamase GIM-1 outbreak driven by plasmids and bacterial clones ofEnterobacter cloacaeandPseudomonas aeruginosain a tertiary care center. Environmental sampling targeting wet locations (especially sinks) was carried out on a surgical intensive care unit and on a medical ward on several occasions in 2012 and 2013. We were able to demonstrate 43blaGIM-1-carrying bacteria (mainly nonfermenters but alsoEnterobacteriaceae) that were either related or unrelated to clinical strains in 30 sinks and one hair washbasin. GIM-1 was found in 12 different species, some of which are described here as carriers of GIM-1. Forty out of 43 bacteria displayed resistance to carbapenems and, in addition, to various non-beta-lactam antibiotics. Colistin resistance was observed in twoE. cloacaeisolates with MICs above 256 mg/liter. TheblaGIM-1gene was harbored in 12 different class 1 integrons, some without the typical 3′ end. TheblaGIM-1gene was localized on plasmids in five isolates.In vitroplasmid transfer by conjugation was successful in one isolate. The environment, with putatively multispecies biofilms, seems to be an important biological niche for multidrug-resistant bacteria and resistance genes. Biofilms may serve as a “melting pot” for horizontal gene transfer, for dissemination into new species, and as a reservoir to propagate future hospital outbreaks.IMPORTANCEIn Gram-negative bacteria, resistance to the clinically relevant broad-spectrum carbapenem antibiotics is a major public health concern. Major reservoirs for these resistant organisms are not only the gastrointestinal tracts of animals and humans but also the (hospital) environment. Due to the difficulty in eradicating biofilm formation in the latter, a sustained dissemination of multidrug-resistant bacteria from the environment can occur. In addition, horizontal transfer of resistance genes on mobile genetic elements within biofilms adds to the total “resistance gene pool” in the environment. To gain insight into the transmission pathways of a rare and locally restricted carbapenemases resistance gene (blaGIM-1), we analyzed the genetic background of theblaGIM-1gene in environmental bacteria during a long-term polyspecies outbreak in a German hospital.

scholarly journals Trends of 9,416 multidrug-resistant Gram-negative bacteria

2015 ◽  
Vol 61 (3) ◽  
pp. 244-249 ◽  
Author(s):  
Viviane Decicera Colombo Oliveira ◽  
Fernando Góngora Rubio ◽  
Margarete Teresa Gottardo Almeida ◽  
Mara Corrêa Lelles Nogueira ◽  
Antonio Carlos Campos Pignatari
Keyword(s):  
Gradual Increase ◽  
Carbapenem Resistance ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Clinical Specimens ◽  
Bacterial Sensitivity ◽  
Hospital Acquired ◽  
Multiple Antibiotics

Summary Objective: a resistance of hospital-acquired bacteria to multiple antibiotics is a major concern worldwide. The objective of this study was to investigate multidrugresistant (MDR) bacteria, clinical specimens, origin of specimen and trends, and correlate these with bacterial sensitivity and consumption of antimicrobials. Methods: 9,416 bacteria of nosocomial origin were evaluated in a tertiary hospital, from 1999 to 2008. MDR was defined for Gram-negative bacteria (GNB) as resistance to two or more classes/groups of antibiotics. Results: GNB MDR increased by 3.7 times over the study period (p<0.001). Acinetobacter baumannii was the most prevalent (36.2%). Over the study period, there were significant 4.8-fold and 14.6-fold increases for A. baumannii and K. pneumoniae (p<0.001), respectively. Sixty-seven percent of isolates of MDR GNB were isolated in intensive care units. The resistance of A. baumannii to carbapenems increased from 7.4 to 57.5% during the study period and concomitant with an increased consumption. Conclusion: that decade showed prevalence of GNB and a gradual increase in MDR GNB. There was an increase in carbapenem resistance of 50.1% during the study.

scholarly journals Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

2012 ◽  
Vol 33 (11) ◽  
pp. 1077-1080 ◽  
Author(s):  
Ruth Meinke ◽  
Bernhard Meyer ◽  
Reno Frei ◽  
Jakob Passweg ◽  
Andreas F. Widmer
Keyword(s):  
Similar Efficacy ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Gram Negative Bacteria ◽  
Current Standard ◽  
Gram Negative ◽  
Selective Media ◽  
Significant Difference ◽  
Hospital Acquired ◽  
Environmental Disinfection

Background.The inanimate hospital environment has emerged as an important reservoir of nosocomial pathogens. In particular, multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus, Acinetobacter species, and Clostridium difficile, play a major role in the transmission of hospital-acquired infections. In Europe, aldehydes, chlorine, and quaternary ammonium compounds have been commonly used for environmental disinfection. Glucoprotamin, a newer active compound for disinfectants, has been clinically tested for disinfection of instruments but not for environmental disinfection.Objective.This study evaluated the antimicrobial effectiveness of a glucoprotamin-containing product (Incidin) compared with that of an aldehyde-containing product (Deconex), the current standard at our institution.Methods.This prospective crossover study was conducted in our access-restricted hematologic transplant unit. A total of 3,086 samples from the environment were processed and examined for overall bacterial burden as well as selectively for S. aureus, C. difficile, and gram-negative bacteria.Results.There was no significant difference in residual bacteria after disinfection between the 2 products in terms of overall burden and selected pathogens. Enterococci were the predominant pathogens recovered from surfaces, but no vancomycin-resistant enterococci were recovered. Similarly, C. difficile could not be found in the patients' environment, even in rooms, despite the use of selective media.Conclusion.The aldehyde-containing product (Deconex) and the glucoprotamin-containing product (Incidin) demonstrated similar efficacy against environmental contamination in a hematologic transplant unit with the application of selective media for C. difficile, S. aureus, and gram-negative bacteria in addition to standard medium.

scholarly journals Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

2020 ◽  
Author(s):  
Laura Saporito ◽  
Giorgio Graziano ◽  
Federica Mescolo ◽  
Emanuele Amodio ◽  
Vincenzo Insinga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Surveillance Program ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Active Surveillance Program

Abstract Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large use of antimicrobial treatment and invasive devices in fragile babies.Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage is in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU.Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy.Findings: During the strengthened microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns.Prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). MDR-GNB were not detected for three months and ESBL-KP for five months. Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR=0.21, 95% CI=0.076-0.629; p<0.001).Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of most dangerous ESBL-KP strains.

scholarly journals Identification of blaGIM-1 in Acinetobacter variabilis isolated from the hospital environment in Tamil Nadu, India

2019 ◽  
Author(s):  
Prasanth Manohar ◽  
Murugavel Ragavi ◽  
Ashby Augustine ◽  
Hrishikesh MV ◽  
Nachimuthu Ramesh
Keyword(s):  
Tamil Nadu ◽  
Carbapenem Resistance ◽  
Resistance Mechanisms ◽  
Hospital Environment ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Hospital Environments ◽  
Surveillance Programs

AbstractBackgroundEmergence of carbapenem resistance mechanisms among Gram-negative bacteria is a worrisome health problem. Here, we focused on to identify the presence of carbapenem-resistant bacteria among the samples collected from hospital environments in Tamil Nadu.MethodsA total of 30 hospital environmental samples were collected between August 2017 and January 2018 from hospitals located in Chennai and Vellore such as lift switches, stair rails, switchboards, nursing desks, used nursing gloves, door handles, wheelchairs, touch screens, chairs and from pillars inside the hospitals.Results and discussionA total of 22 carbapenem-resistant Gram-negative bacteria were isolated that included Escherichia coli, Klebsiella sp., Enterobacter sp., Salmonella sp., Pseudomonas aeruginosa and Acinetobacter sp. Interestingly, blaGIM-1 was detected in Acinetobacter variabilis strain isolated in samples collected from hospitals. Unlike other studies, the identified GIM-1 was not plasmid encoded, and this is the first report for the presence of GIM-1 (German imipenemase) in India.ConclusionExtensive surveillance programs are necessary to trace the uncontrolled spread of carbapenem-resistance genes in order to reduce the rapid spread of resistance.

scholarly journals Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Saporito ◽  
Giorgio Graziano ◽  
Federica Mescolo ◽  
Emanuele Amodio ◽  
Vincenzo Insinga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Surveillance Program ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Active Surveillance Program

Abstract Background Antimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP), was observed in “Civico” hospital NICU. Aim To assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU. Methods Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies. Findings During the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%; p < 0.001 and 11.1% vs 57.8%; p < 0.001). MDR-GNB were not detected at all for three months and ESBL-KP for five months. Multivariate analysis of the principal exposure variables showed that admission in the post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR = 0.21, 95% CI = 0.076–0.629; p < 0.001). Conclusions MDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.

scholarly journals Isolation and Antibiotic Susceptibility of the Microorganisms Isolated from Diabetic Foot Infections in Nemazee Hospital, Southern Iran

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Mojtaba Anvarinejad ◽  
Gholamreza Pouladfar ◽  
Aziz Japoni ◽  
Shahram Bolandparvaz ◽  
Zeinab Satiary ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Antibiotic Sensitivity ◽  
Empirical Therapy ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Public Health Issue ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Diabetic Foot Infections

Background. Diabetic foot infections (DFIs) are a major public health issue and identification of the microorganisms causing such polymicrobial infections is useful to find out appropriate antibiotic therapy. Meanwhile, many reports have shown antibiotic resistance rising dramatically. In the present study, we sought to determine the prevalence of microorganisms detected on culture in complicated DFIs in hospitalized patients and their antibiotic sensitivity profiles.Methods. A cross-sectional study was conducted for a period of 24 months from 2012 to 2014 in Nemazee Hospital, Shiraz, Iran. The demographic and clinical features of the patients were obtained. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method.Results. During this period, 122 aerobic microorganisms were isolated from DFIs. Among Gram-positive and Gram-negative bacteria,Staphylococcusspp. andE. coliwere the most frequent organisms isolated, respectively. Of the isolates, 91% were multidrug while 78% ofS. aureusisolates were methicillin resistant. 53% of Gram-negative bacteria were positive for extended-spectrumβ-lactamase.Conclusion. Given the involvement of different microorganisms and emergence of multidrug resistant strains, clinicians are advised to consider culture before initiation of empirical therapy.

scholarly journals Laboratory Diagnostic Approach and Interpretation in Gram-Negative Bacterial Infection: A-Case Report of Sepsis in Secondary Hospital Settings

2020 ◽  
Vol 26 (3) ◽  
Author(s):  
Adhi Kristianto Sugianli ◽  
Ida Parwati
Keyword(s):  
Case Report ◽  
Positive Culture ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Extended Spectrum Beta Lactamases ◽  
Secondary Hospital

Gram-Negative Bacteria (GNB) have been widely reported to cause worldwide infections and life-threatening. The high prevalence of drug-resistant GNB causes the treatment of GNB to become difficult. This case report describes a stepwise laboratory approach and interpretation for Gram-negative bacteria infection in sepsis patients. An 84-year-old female patient with a history of congestive heart failure, after three weeks of hospitalization, GNB was proven as the cause of sepsis. Laboratory approach for inflammation (C-reactive protein, procalcitonin) was made and confirmed with a positive culture of several specimens (sputum, urine, and blood). The identification of bacterial-culture revealed as Carbapenem-resistance Klebsiella pneumoniae and Extended-spectrum Beta-lactamases Escherichia coli. This case highlights GNB as a potential agent to worsen the infection (sepsis) and also a useful approach for the detection of multidrug-resistant bacteria, particularly in secondary hospital settings. The application and interpretation of integrated clinical and laboratory criteria may bring out better and effective patient management.

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

2014 ◽  
Vol 35 (4) ◽  
pp. 362-366 ◽  
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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