scholarly journals Successful Treatment of Klebsiella pneumoniae Harboring a Klebsiella pneumoniae Carbapenemase Isolated from Lumbar Wound Infection and Blood in a Patient with Hardware Retention

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Alan Bulbin ◽  
Carol Bono ◽  
Tena Philp ◽  
Noriel Mariano ◽  
Carl Urban
Keyword(s):  
Klebsiella Pneumoniae ◽  
Disease Control ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Spinal Stenosis ◽  
Posterior Spinal Fusion ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Carbapenem Resistant Enterobacteriaceae

Infections caused by carbapenem-resistant Enterobacteriaceae, especially carbapenemase producing Klebsiella pneumoniae, represent an urgent threat as outlined by the Centers for Disease Control and Prevention (CDC). We present a 66-year-old male with spinal stenosis who underwent elective L2-pelvis posterior spinal fusion at an outside institution and rapidly developed a complicated infection with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase. This is the first described case of a patient with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase causing postoperative lumbar wound infection and bacteremia, successfully treated with ceftazidime-avibactam in combination with additional synergistic antibacterials and without hardware removal.

scholarly journals 843. Increased Carbapenemase Testing Following Implementation of VA Guidelines for Carbapenem-Resistant Enterobacteriaceae (CRE)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S462-S462
Author(s):  
Margaret A Fitzpatrick ◽  
Katie J Suda ◽  
Swetha Ramanathan ◽  
Geneva M Wilson ◽  
Makoto M Jones ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Retrospective Cohort ◽  
Low Complexity ◽  
Descriptive Statistics ◽  
High Complexity ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
The U.S ◽  
Over Time ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are a substantial burden, with recent data showing no change in hospital CRE between 2012-2017. All carbapenemases produced by CRE have been identified in the U.S., however trends in testing and detection over time have not been well described. Trends in carbapenemase testing in the VA, 2013-2018 Methods A retrospective cohort study of Veterans hospitalized between 2013-2018 with CRE cultures defined by either 2015 or 2017 VA guidelines. In general, this was Escherichia coli, Klebsiella pneumoniae/oxytoca, or Enterobacter spp. non-susceptible to imipenem, meropenem, and/or doripenem, and to 3rd generation cephalosporins for 2015 definition. Testing for Klebsiella pneumoniae carbapenemase (KPC), New Dehli metallo-β-lactamase (NDM), Verona integron-encoded metallo-β-lactamase (VIM), Imipenemase (IMP), and Oxacillinase-48-like (OXA-48) was summarized with descriptive statistics. Facility characteristics assessed included region, complexity, and rurality. Results Out of 5,778 CRE cultures, 1,900 (32.9%) were tested for carbapenemases and 1,612 (84.8%) of these had carbapenemases detected. Among CP-CRE cultures, 1,042 (64.6%) had testing for ≥1 genetic mechanism; all tests included KPC. Testing for NDM (n=585, 56.1%), VIM (n=102, 9.8%), IMP (n=102, 9.8%), and OXA-48 (n=507, 48.7%) was less frequent. KPC was detected in 915/1,042 cultures (87.8%), while NDM (n=7/585, 1.2%) was rarely detected. There were no cases of VIM, IMP, or OXA-48. Carbapenemase testing increased significantly over the study period; KPC, NDM, and OXA-48 were the predominant mechanisms tested (Figure 1). The South (38.6%) and Northeast (37.2%) had the highest proportion of CRE with carbapenemase testing. High complexity (vs low) and urban (vs rural) facilities were significantly associated with carbapenemase testing (p< 0.001). Conclusion Following publication of initial CRE guidelines in 2015, carbapenemase testing and detection increased in the VA, although tests for non-KPC carbapenemases were less frequent. Surveillance of non-KPC carbapenemases is important due to global dissemination and enhanced antibiotic resistance. Efforts should support carbapenemase testing in low complexity, rural facilities in the Midwest and West. Disclosures All Authors: No reported disclosures

Genotypes and prevalence of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa in a hospital in Saudi Arabia

2021 ◽  
Author(s):  
Jaffar A Al-Tawfiq ◽  
Ali A Rabaan ◽  
Justin V Saunar ◽  
Ali M Bazzi
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Saudi Arabia ◽  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
New Delhi ◽  
Beta Lactam ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The molecular epidemiology of resistance of carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas aeruginosa are important in the study of multidrug-resistant bacteria. We evaluate the prevalence of the different mechanisms of CRE in a hospital in Saudi Arabia. Methods Carbapenem non-susceptible isolates of Enterobacteriaceae and Pseudomonas aeruginosa were tested by real-time PCR for the detection of genes responsible for beta-lactam resistance. Results There were a total of 200 isolates with carbapenem non-susceptibility and these were Klebsiella pneumoniae (n=96, 48%), Escherichia coli (n=51, 25.5%) and Pseudomonas aeruginosa (n=45, 22.5%). The detected carbapenemases were oxacillinase-48 (OXA-48) (n=83, 41.5%), New Delhi metallo-β-lactamase (NDM) (n=19, 2.5%) and both NDM and OXA-48 (n=5, 2.5%). The other carbapenemases were imipenemase (n=1, 0.5%), Verona integrin encoded metallo-β-lactamase (n=6, 3%) and Klebsiella pneumoniae carbapenemase (n=1, 0.5%), but none were detected in 86 isolates (43%). Conclusion The most common carbapenemases were OXA-48 and a significant percentage had no detectable genes. These data will help in the selection of new antimicrobial therapies.

scholarly journals 704. Klebsiella pneumoniae Carbapenemase and Verona Integron-Encoded Metallo-β-Lactamase Among Carbapenem-Resistant Enterobacteriaceae in Kentucky

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S253-S254
Author(s):  
Kevin Spicer ◽  
Lynn Roser ◽  
Andrea Flinchum
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Urban Areas ◽  
Demographic Data ◽  
Healthcare Facilities ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Klebsiella pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) have been the most commonly identified carbapenemases among carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) in Kentucky since 2013. Understanding the frequency and epidemiology of these CP-CRE can help inform prevention strategies. Methods We reviewed reports of KPC- and VIM-producing CRE from January 2013 through December 2017. CRE became reportable in Kentucky in February 2015 and statewide request to laboratories and healthcare facilities for isolate submission for mechanism testing was made in September 2017. Prior to that time, mechanism testing for CRE was conducted at a limited number of laboratories or during outbreak investigations. Demographic data included age, sex, and inpatient or outpatient status. Descriptive analyses were performed. Results As of December 31, 2017, a total of 156 CP-CRE isolates had been identified (124 KPC, 31 VIM, 1 NDM), with an increase from 2013 (n = 13) to 2017 (n = 48). KPC was identified in isolates from 124 patients; VIM was identified in isolates from 26 patients, with 4 patients (15%) having multiple organisms with the mechanism. KPC was identified most commonly from Klebsiella pneumoniae (57/124, 46%); VIM was identified most commonly from Enterobacter cloacae (14/31, 45%). KPC was found in 6 different Enterobacteriaceae genera; VIM in 4. KPC-producing CRE were identified in 22 acute-care and long-term acute-care facilities in 14 counties, with nine reporting >2 isolates. Fifteen percent (19/124) of KPC-producing CRE were isolated from outpatients. VIM-producing CRE were identified in two acute-care facilities located in two urban areas; one was from an outpatient. Patients with VIM were younger than those with KPC (43 vs. 60 years, P < 0.001). Conclusion KPC is the predominant carbapenemase in Kentucky and is more widely disseminated than VIM, which has been limited to two facilities. CRE reporting and mechanism testing have yielded a greater understanding of regional CRE epidemiology and has the potential to facilitate response efforts to slow further spread. Disclosures All authors: No reported disclosures.

scholarly journals Klebsiella pneumoniae Carbapenemase (KPC)–Producing K. pneumoniae Contamination of an In-Room Sink in a New Bed Tower

2021 ◽  
Vol 1 (S1) ◽  
pp. s73-s73
Author(s):  
Bobby Warren ◽  
Becky Smith ◽  
Sarah Lewis ◽  
Deverick Anderson ◽  
Bechtler Addison
Keyword(s):  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Routine Surveillance ◽  
Colony Forming Units ◽  
Time Of Admission ◽  
Uv C ◽  
New Strategies ◽  
Carbapenem Resistant Enterobacteriaceae

Group Name: Duke Center for Antimicrobial Stewardship and Infection PreventionBackground: Wastewater drains in hospital patient rooms have been identified as environmental reservoirs for multidrug-resistant organisms, and they have been linked to outbreaks of carbapenem-resistant Enterobacteriaceae (CRE). We studied the colonization of wastewater drains in a new hospital bed tower. Methods: A patient care unit in a new bed tower opened on July 18, 2020. In-room sinks were located in each hospital room opposite the patient head wall. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CRE. Cultures were performed from all patient room sinks in this unit monthly beginning September 14, 2020. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tail-pipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the P-trap water was sampled with sterile tubing attached to a 50-mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex media and were incubated at 37°C for 24 hours. Results: The first identified CRE-positive patient was admitted to the new unit on December 4, 2020; urine culture obtained at the time of admission grew KPC–producing Klebsiella pneumoniae (KPC-KP). The sink in this patient’s room had been sampled 3 prior times (most recently on November 9, 2020) and was negative for CRE. On December 7, 2020, KPC-KP was found on the drain cover (6,750 colony-forming units, CFU) and in the sink’s P-trap (1,840 CFU) of the index patient’s room during routine sink surveillance. Additional samples from other room surfaces were taken on December 9, 2020, and KPC-KP was recovered from the computer keyboard (452 CFU) and patient bedrails (880 CFU). The patient was discharged from this room December 13, 2020, and the room underwent enhanced terminal room cleaning including UV-C light. On the next routine sink sampling on January 4, 2021, KPC-KP was recovered again in the index room sink P-trap (9,800 CFU) but at no additional sites. MLST was performed, and all isolates were ST-258. Conclusions: In a new bed tower with no prior evidence of CRE-positive patients, the first identified case of a CRE (KPC-KP) in a patient resulted in widespread environmental contamination of the room after only 3 days of hospitalization and contamination of the in-room sink drain that persisted after 1 month. Given the ease with which CRE colonizes wastewater drains, new strategies are needed to mitigate drain colonization and to prevent CRE transmission to subsequent patients.Funding: NoDisclosures: None

scholarly journals Molecular characterization of carbapenem-resistant Klebsiella pneumoniae isolates from a university hospital in Brazil

2017 ◽  
Vol 11 (05) ◽  
pp. 379-386 ◽  
Author(s):  
Ana Carolina Polano Vivan ◽  
Juliana Ferraz Rosa ◽  
Camila Fonseca Rizek ◽  
Marsileni Pelisson ◽  
Silvia Figueiredo Costa ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Outer Membrane Proteins ◽  
University Hospital ◽  
Pcr Analysis ◽  
Extended Spectrum Beta Lactamase ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Sds Page ◽  
Control And Prevention ◽  
The University

Introduction: The emergence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kpn) isolates is attracting significant attention in nosocomial infection settings. K. pneumoniae is the main pathogen that harbours blaKPC genes. Methodology: This study evaluated 54 K. pneumoniae carbapenem-resistant isolates from patients hospitalized at the University Hospital of Londrina, between July 2009 and July 2010. The isolates were phenotypically screened for carbapenemase production and submitted for genotypic confirmation by polymerase chain reaction (PCR) for KPC, metallo-β-lactamases, OXA-48, and extended-spectrum beta-lactamase genes. The absence of outer membrane proteins (OMP) was investigated by SDS-PAGE. The susceptibility profile was determined by broth microdilution, according to Clinical and Laboratory Standards Institute protocol. Results: All isolates were phenotypically positive for class A carbapenemase production, but negative for metallo-β-lactamase activity. PCR analysis demonstrated that all isolates carried blaKPC genes and sequencing showed that all strains belonged to KPC-2 subtype. Four strains did not show porin expression, and all isolates were resistant to ertapenem, meropenem, and imipenem. Susceptibility rates reached 35.2% for gentamicin, 85.2% for polymixyn B, 87% for colistin, and 98.1% for both tigecycline and fosfomycin. Pulsed-field gel electrophoresis showed six clones, and three of them predominated among the isolates. Conclusions: KPC-2-producing K. pneumoniae is becoming predominant among carbapenem-resistant K. pneumoniae isolates at the hospital. The association of the enzyme KPC with other resistance determinants, such as loss of porins, may increase the severity of the situation of nosocomial infections. There is an urgent need to develop strategies for infection control and prevention.

scholarly journals Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

2021 ◽  
Author(s):  
Ashoka Mahapatra ◽  
K Nikitha ◽  
Sutapa Rath ◽  
Bijayini Behera ◽  
Kavita Gupta
Keyword(s):  
Tertiary Care ◽  
High Sensitivity ◽  
Care Hospital ◽  
Predictive Values ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Rectal Swabs ◽  
Control And Prevention ◽  
Indian Setting ◽  
Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

scholarly journals A Bibliometric Meta-Analysis of Colistin Resistance in Klebsiella pneumoniae

Diseases ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 44
Author(s):  
Ozioma Forstinus Nwabor ◽  
Pawarisa Terbtothakun ◽  
Supayang P. Voravuthikunchai ◽  
Sarunyou Chusri
Keyword(s):  
Klebsiella Pneumoniae ◽  
Research Collaboration ◽  
Research Output ◽  
Meta Analysis ◽  
Research Articles ◽  
Colistin Resistance ◽  
Carbapenem Resistant ◽  
The Usa ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Linkage Strength

Colistin is a last resort antibiotic medication for the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae. In recent years, various mechanisms have been reported to mediate colistin resistance in K. pneumoniae. This study reports a bibliometric analysis of published articles retrieved from the Scopus database relating to colistin resistance in K. pneumoniae. The research trends in colistin resistance and mechanisms of resistance were considered. A total of 1819 research articles published between 1995 and 2019 were retrieved, and the results indicated that 50.19% of the documents were published within 2017–2019. The USA had the highest participation with 340 (14.31%) articles and 14087 (17.61%) citations. Classification based on the WHO global epidemiological regions showed that the European Region contributed 42% of the articles while the American Region contributed 21%. The result further indicated that 45 countries had published at least 10 documents with strong international collaborations amounting to 272 links and a total linkage strength of 735. A total of 2282 keywords were retrieved; however, 57 keywords had ≥15 occurrences with 764 links and a total linkage strength of 2388. Furthermore, mcr-1, colistin resistance, NDM, mgrB, ceftazidime-avibactam, MDR, combination therapy, and carbapenem-resistant Enterobacteriaceae were the trending keywords. Concerning funders, the USA National Institute of Health funded 9.1% of the total research articles, topping the list. The analysis indicated poor research output, collaboration, and funding from Africa and South-East Asia and demands for improvement in international research collaboration.

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