Phenotypic and Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae from Clinical Bacterial Isolates: A Multicenter Retrospective Chart Review Study in western of Saudi Arabia

Abstract Background: Carbapenemase-producing bacteria are a major health problem because of its limited treatment options. Carbapenem-Resistant Enterobacteriaceae (CRE) are non-susceptible to carbapenem, which serves as the most potent class of antimicrobial agents available for multidrug-resistant bacterial infections. The aim of our study was to determine the prevalence of CRE and determine the type of carbapenemase genes present among patients in tertiary care hospitals in Jeddah, Saudi Arabia.Methods: We performed a retrospective chart review on 180 patients in two sites. Primarily, we evaluated the prevalence of KPC, NDM, VIM, OXA-48, and IMP genes of CRE from clinical isolates tested by Xpert® Carba-R. Secondly, we assessed the prevalence of CRE based on antibiogram reports and described the susceptibility of CRE and the aforementioned CRE genes to antimicrobial agents.Results: CRE clinical isolates showed no occurrence of KPC, VIM, and IMP genes. OXA-48 gene was predominantly prevalent, with 76.1%, followed by NDM 13.9%, and both genes co-existed in 6.1% of the isolates. The CRE percent prevalence in one site in 2017 was 3.8%, and increased to 6.03% in 2018, whereas in the second site, the percentage was much higher, reaching 22.9% in 2018 and 18.9% in 2019. The CRE prevalence was dominated by Klebsiella pneumoniae (K. pne), occurring in 92.8% of the isolates, followed by E. coli in 6.7%. K. pne showed a higher frequency of OXA-48 (79%) than NDM (11.7%) genes, with a p-value of 0.007, while E. coli showed an equal frequency of both genes (41.7%). K. pne and E. coli showed high antimicrobial resistance to imipenem, meropenem, tazocin, and ciprofloxacin. However, they showed less resistance to amikacin, gentamycin, and tigecycline. NDM and OXA-48 genes showed 100% resistance to imipenem, meropenem, tazocin, ciprofloxacin and amikacin and the lowest resistance to gentamycin, tigecycline, and colistin.Conclusion: Over the two year retrospective study period, the CRE percent prevalence in the evaluated clinical isolates has remarkably increased. K. pne and E. coli were the most prevalent CRE organisms with OXA-48 and NDM as the predominant genes. CRE organisms and genes showed high antimicrobial resistance to imipenem, meropenem and tazocin, and lower resistance to gentamycin and tigecycline.

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Detection of antimicrobial resistance genes of carbapenem-resistant Enterobacteriaceae in Escherichia coli isolated from the water supply of smallholder dairy farms in Saraburi and Maha Sarakham, Thailand

International Journal of One Health ◽

10.14202/ijoh.2020.1-5 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1-5

Author(s):

Natapol Pumipuntu ◽

Sangkom Pumipuntu

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Resistance Genes ◽

Water Samples ◽

Dairy Farms ◽

Drug Resistant ◽

E Coli ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae ◽

Smallholder Dairy Farms

Background and Aim: The problem of antimicrobial resistance of bacteria in both humans and animals is an important public health concern globally, which is likely to increase, including in Thailand, where carbapenem-resistant Enterobacteriaceae (CRE), such as Escherichia coli, are of particular concern. They are pathogens found in the gastrointestinal tract of humans and other animals as well as in the environment. They may cause opportunistic infection and are often resistant to antibiotics in various fields especially in animal husbandry, such as pets or livestock farms. This study aimed to investigate the occurrence of carbapenem-resistant E. coli from water samples of smallholder dairy farms in Saraburi and Maha Sarakham, Thailand. Materials and Methods: Sixty-four water samples were collected from 32 dairy farms in Kaeng Khoi district, Muak Lek district, and Wang Muang district of Saraburi Province, and Kantharawichai district and Mueang district of Maha Sarakham Province, Thailand. All samples were cultured and isolated for E. coli by biochemical tests. All E. coli isolates were tested for drug susceptibility using imipenem, meropenem, and drug resistance genes of carbapenemases such as blaNDM, blaIMP, and blaOXA48 of drug-resistant E. coli isolates detected by polymerase chain reaction (PCR) technique. Results: A total of 182 E. coli isolates were found (140 and 42 isolates from Saraburi and Maha Sarakham, respectively). Drug sensitivity tests found that two isolates of E. coli from water in Kaeng Khoi were resistant to imipenem; therefore, the incidence of E. coli resistance to carbapenem was 1.43% of Saraburi Province. On the other hand, there was no incidence of drug-resistant E. coli in Maha Sarakham. In addition, the detection of the drug-resistant gene of E. coli in both isolates by PCR showed the expression of blaNDM. Conclusion: This study reports E. coli resistance to antimicrobial drugs on livestock farms. It can be considered to be the first report of E. coli CRE detection in a dairy farm at Saraburi, which should be the subject of further extended study.

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The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

10.21203/rs.2.10825/v1 ◽

2019 ◽

Author(s):

Xiu-Qin Jia ◽

Feng Pang ◽

Xin Luo ◽

Jian Zhang

Keyword(s):

Antimicrobial Resistance ◽

Adjuvant Therapy ◽

Pathogenic Bacteria ◽

Antimicrobial Agents ◽

Pediatric Patients ◽

Tertiary Hospital ◽

Invasive Procedures ◽

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background The aim of this study was to performe a retrospective analysis of prevalence and treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections in children in a tertiary hospital. Methods The non-repeat clinical isolates of CRE in children were collected in Liaocheng People's Hospital from January, 2013 to December, 2018. The bacterial identification and antibiotic susceptibility was performed according to the standard methods. The isolated strains will be detected carbapenemases genotypes and homology analysis. All data on the culture-positive strains and associated clinical infection from different pediatric wards were reviewed. Results A total of 20 CRE strains isolated from pediatric patients, which derived from different infection sites and present a classification of multiple species of Enterobacteriaceae. And the production of IMP-type carbapenemase in these strains is the main reason of antimicrobial resistance. Most of the infected patients have severe comorbidities and invasive procedures, and use insensitive drugs due to the high resistance rates and medication restrictions. Nevertheless, most infected children have been treated despite the resistance of pathogens to multiple antimicrobial agents. In our follow-up survey, most children received adjuvant therapy such as human intravenous immunoglobulin, which may be an important factor in helping patients defeat pathogenic bacteria. Conclusions This study demonstrates a high prevalence of IMP-mediated CRE infection in pediatric patients with severe comorbidities and invasive procedures. Most children have been cured, which may be related to application of adjuvant therapy and weaker pathogenicity of the IMP-type Enterobacteriaceae.

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Activity of Meropenem-Vaborbactam Against Enterobacteriaceae Isolates Carrying blaKPC Collected Worldwide

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.930 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S377-S377 ◽

Cited By ~ 1

Author(s):

Mariana Castanheira ◽

Rodrigo E Mendes ◽

Leonard R Duncan ◽

Leah N Woosley ◽

Robert K Flamm

Keyword(s):

Antimicrobial Agents ◽

Active Agent ◽

E Coli ◽

Microdilution Method ◽

Carbapenem Resistant ◽

Broth Microdilution Method ◽

Wholly Owned Subsidiary ◽

Us Fda ◽

Carbapenem Resistant Enterobacteriaceae ◽

Research Grant

Abstract Background Meropenem-vaborbactam (MER-VAB) is a carbapenem-β-lactamase inhibitor combination with enhanced activity against KPC-producing Enterobacteriaceae recently evaluated in a phase 3 clinical trials for cUTIs and infections due to CRE. We analyzed the activity of MER-VAB against 517 isolates carrying blaKPC collected worldwide during 2014–16. Methods Enterobacteriaceae isolates (n = 34,069) from 34 countries were susceptibility (S) tested by reference broth microdilution method for MER-VAB (at fixed 8 µg/mL) and comparators. Carbapenem-resistant Enterobacteriaceae (CRE; CLSI criteria) were submitted to PCR/Sanger sequencing or next-generation sequencing for blaKPC screening. Results A total of 517 (1.5%) carried blaKPC and 6 variants were observed: 293 blaKPC-3, 218 blaKPC-2, 2 blaKPC-4, 2 blaKPC-17, and 1 each of blaKPC-2-like and blaKPC-12. Isolates were mainly K. pneumoniae (437), but also 32 E. cloacae, 13 K. oxytoca, 12 E. coli, 12 S. marcescens, and 4 other species. Isolates carrying blaKPC were detected in 17 countries. The occurrence ranged from <0.1% to 11.3%, being higher in Brazil, Italy (9.3%), Poland (5.6%), and Argentina (5.2%). MER-VAB inhibited 514/517 (99.4%) isolates carrying blaKPC at ≤8 µg/mL and this compound was the most active agent tested against these isolates (MIC50/90, 0.12/1 µg/mL). Three isolates displaying elevated MER-VAB MIC values (>8 µg/mL) co-harbored blaNDM-1 or blaOXA-48-like in addition to blaKPC or had a missense mutation on OmpK35. MER alone (MIC50/90, 32/>32 µg/mL), imipenem (MIC50/90, >8/>8 µg/mL), and doripenem (MIC50/90, >4/>4 µg/mL) were not active against isolates harboring blaKPC. Amikacin (MIC50/90, 16/>32 µg/mL) and gentamicin (MIC50/90, 2/>8) µg/mL inhibited only 54.9% and 57.3% of the isolates (CLSI breakpoint). Colistin (MIC50/90, ≤0.5/>8 µg/mL; 70.4% S/EUCAST breakpoint) and tigecycline (MIC50/90, 0.5/1 µg/mL; 99.4% S/US FDA criteria) were the most active comparators. Conclusion The occurrence of blaKPC is still low overall, but can be as high as 5–10% in a few countries and occur in species other than Klebsiella. KPC-producers are highly resistant to available antimicrobial agents and MER-VAB will be a useful alternative to treat infections caused by these organisms. Disclosures M. Castanheira, Rempex, a wholly owned subsidiary of The Medicines Company: Research Contractor, Research grant; R. E. Mendes, Rempex, a wholly owned subsidiary of The Medicines Company: Research Contractor, Research grant; L. R. Duncan, Rempex, a wholly owned subsidiary of The Medicines Company: Research Contractor, Research grant; L. N. Woosley, Rempex, a wholly owned subsidiary of The Medicines Company: Research Contractor, Research grant; R. K. Flamm, Rempex, a wholly owned subsidiary of The Medicines Company: Research Contractor, Research grant

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Multicenter Study of Outcomes with Ceftazidime-Avibactam in Patients with Carbapenem-Resistant Enterobacteriaceae Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00449-17 ◽

2017 ◽

Vol 61 (7) ◽

Cited By ~ 42

Author(s):

Madeline King ◽

Emily Heil ◽

Safia Kuriakose ◽

Tiffany Bias ◽

Vanthida Huang ◽

...

Keyword(s):

Chart Review ◽

Clinical Success ◽

Retrospective Chart Review ◽

Beta Lactamase ◽

Content Type ◽

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

Microbiological Cure ◽

Inhibitor Combination ◽

Carbapenem Resistant Enterobacteriaceae

ABSTRACT Ceftazidime-avibactam is a novel cephalosporin–beta-lactamase inhibitor combination that is active against many carbapenem-resistant Enterobacteriaceae (CRE). We describe a retrospective chart review for 60 patients who received ceftazidime-avibactam for a CRE infection. In-hospital mortality was 32%, 53% of patients had microbiological cure, and 65% had clinical success. In this severely ill population with CRE infections, ceftazidime-avibactam was an appropriate option.

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Whole-Genome Sequencing for Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae Causing Lower Urinary Tract Infection among Pediatric Patients

Antibiotics ◽

10.3390/antibiotics10080972 ◽

2021 ◽

Vol 10 (8) ◽

pp. 972

Author(s):

Hassan Al Mana ◽

Sathyavathi Sundararaju ◽

Clement K. M. Tsui ◽

Andres Perez-Lopez ◽

Hadi Yassine ◽

...

Keyword(s):

Urinary Tract ◽

Antimicrobial Resistance ◽

Whole Genome Sequencing ◽

Genome Sequencing ◽

Bacterial Species ◽

Whole Genome ◽

E Coli ◽

Carbapenem Resistant ◽

Tract Infections ◽

Carbapenem Resistant Enterobacteriaceae

Antibiotic resistance is a growing public health problem globally, incurring health and cost burdens. The occurrence of antibiotic-resistant bacterial infections has increased significantly over the years. Gram-negative bacteria display the broadest resistance range, with bacterial species expressing extended-spectrum β-lactamases (ESBLs), AmpC, and carbapenemases. All carbapenem-resistant Enterobacteriaceae (CRE) isolates from pediatric urinary tract infections (UTIs) between October 2015 and November 2019 (n = 30). All isolates underwent antimicrobial resistance phenotypic testing using the Phoenix NMIC/ID-5 panel, and carbapenemase production was confirmed using the NG-Test CARBA 5 assay. Whole-genome sequencing was performed on the CREs. The sequence type was identified using the Achtman multi-locus sequence typing scheme, and antimicrobial resistance markers were identified using ResFinder and the CARD database. The most common pathogens causing CRE UTIs were E. coli (63.3%) and K. pneumoniae (30%). The most common carbapenemases produced were OXA-48-like enzymes (46.6%) and NDM enzymes (40%). Additionally, one E. coli harbored IMP-26, and two K. pneumoniae possessed mutations in ompK37 and/or ompK36. Lastly, one E. coli had a mutation in the marA porin and efflux pump regulator. The findings highlight the difference in CRE epidemiology in the pediatric population compared to Qatar’s adult population, where NDM carbapenemases are more common.

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Susceptibility to antibiotics in escherichiae isolated in a multidisciplinary medical centre

Journal of obstetrics and women s diseases ◽

10.17816/jowd65483-89 ◽

2016 ◽

Vol 65 (4) ◽

pp. 83-89

Author(s):

Nadezda S. Kozlova ◽

Natalia E. Barantsevich ◽

Elena P. Barantsevich

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Multidrug Resistance ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

E Coli ◽

Microdilution Method ◽

Carbapenem Resistant ◽

Resistant Strains ◽

High Level

Relevance. Antimicrobial resistance in nosocomial strains currently presents a very important problem. Aim of the study: Study of antibiotic resistance in Escherichia coli, isolated in a multidisciplinary centre. Materials and Methods. Susceptibility of 151 E. coli strains to 15 antibiotics was studied by microdilution method. Results. The majority of the studied strains were resistant to antibiotics, including: ampicillin (57.0%), ciprofloxacin and moxifloxacin (42.4% each), III and IV generation cephalosporins (37.1% and 34.4%, respectively) and gentamycin (29.1%). The highest activity against E. coliwas shown for carbapenems (resistance to erthapenem – 2.6%, meropenem – 0.7%), in particular, for imipenem – no strains resistant to this drug were isolated. Resistance to amikacin and phosphomycin was low: 3.3% and 1.3% respectively. Wide diversity of antibiotic resistance spectra was revealed in studied strains, with a high level of multidrug resistance (48.0%). Conclusion. Study of susceptibility to antimicrobial agents in E. coli, isolated in a multidisciplinary centre, showed predominance of resistant strains with a high level of multidrug resistance. The appearance of carbapenem-resistant strains in a multidisciplinary centre presents a rising problem.

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Detection of themcr-1Colistin Resistance Gene in Carbapenem-Resistant Enterobacteriaceae from Different Hospitals in China

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00440-16 ◽

2016 ◽

Vol 60 (8) ◽

pp. 5033-5035 ◽

Cited By ~ 60

Author(s):

Hua Yu ◽

Fen Qu ◽

Bin Shan ◽

Bin Huang ◽

Wei Jia ◽

...

Keyword(s):

Escherichia Coli ◽

Global Health ◽

Resistance Gene ◽

Clinical Isolates ◽

Chromosomal Integration ◽

Colistin Resistance ◽

Content Type ◽

E Coli ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

ABSTRACTThe spread of the plasmid-mediated colistin resistance gene,mcr-1, into carbapenem-resistantEnterobacteriaceae(CRE) clinical isolates poses a significant threat to global health. Here we report the identification of threemcr-1-harboring carbapenem-resistantEscherichia colistrains, collected from three patients in two provinces in China. Our results show thatmcr-1-harboring CRE strains have started to spread in different hospitals in China. In addition, this report presents the first description of chromosomal integration ofmcr-1into a carbapenem-resistantE. colistrain.

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Susceptibility and Multidrug Resistance Patterns of Escherichia coli Isolated from Cloacal Swabs of Live Broiler Chickens in Bangladesh

Pathogens ◽

10.3390/pathogens8030118 ◽

2019 ◽

Vol 8 (3) ◽

pp. 118 ◽

Cited By ~ 10

Author(s):

Muha. Ajijur Rahman Al Azad ◽

Md. Masudur Rahman ◽

Ruhul Amin ◽

Mst. Ismat Ara Begum ◽

Reinhard Fries ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Broiler Chickens ◽

Antimicrobial Agents ◽

Diffusion Method ◽

Multi Drug Resistance ◽

Major Health Problem ◽

E Coli ◽

Antimicrobial Resistance Gene ◽

Resistance Patterns

Antimicrobial resistance is a major health problem, particularly in developing countries like Bangladesh, where there is a paucity of information on resistance patterns and prevalence of antimicrobial determinants. Therefore, the aims of this study were to investigate the prevalence of resistance, including multi-drug resistance (MDR), and the associated genetic determinants in Escherichia coli isolates from cloacal swabs of live broiler chickens in Bangladesh. Altogether, 400 cloacal swabs (200 from Rajshahi and 200 from Dhaka divisions) were randomly collected from individual chickens in 50 broiler farms. E. coli was isolated and identified using conventional bacteriological culture and biochemical methods. The isolates were further confirmed using genus-specific 16S rRNAtargeted polymerase chain reaction (PCR) primers. Antimicrobial susceptibilities and MDR of the isolates against nine different antimicrobial agents (ampicillin, erythromycin, tetracycline, gentamicin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, colistin sulphate, and streptomycin) were determined using the Kirby-Bauer disc diffusion method. Resistance determinants of E. coli to ampicillin (blaTEM), streptomycin (aadA1), erythromycin [ere(A)], trimethoprim (dfrA1), and tetracycline [tet(A), tet(B)] were screened using PCR. Our results showed that all swab samples were positive for E. coli. The isolates were uniformly resistant to ampicillin, tetracycline, streptomycin, ciprofloxacin, erythromycin, and trimethoprim-sulphamethoxazole. The isolates exhibited highest susceptibility to colistin sulphate (73.5%), followed by gentamicin (49%), and levofloxacin (17%). All isolates were resistant to three classes of antibiotics, 204 isolates (51%) were resistant to four classes, and 56 isolates (14%) were resistant to five. The highest prevalence of antimicrobial resistance gene was recorded for tetracycline (tet(A):95.25%; tet(B):95.25%) followed by ampicillin (blaTEM:91.25%), streptomycin (aadA1:88.25%), erythromycin (ere(A):84.75%), and trimethoprim (dfrA1:65.5%). In conclusion, surveillance for MDR bacteria in poultry is a critical piece of knowledge, which would be useful for optimizing empiric antimicrobial treatments and exploring alternative antimicrobial agents.

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

Pathogens and Disease ◽

10.1093/femspd/ftz040 ◽

2019 ◽

Vol 77 (4) ◽

Cited By ~ 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.

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Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007

Infection Control and Hospital Epidemiology ◽

10.1086/591861 ◽

2008 ◽

Vol 29 (11) ◽

pp. 996-1011 ◽

Cited By ~ 1307

Author(s):

Alicia I. Hidron ◽

Jonathan R. Edwards ◽

Jean Patel ◽

Teresa C. Horan ◽

Dawn M. Sievert ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Healthcare Associated Infections ◽

E Coli ◽

National Healthcare ◽

Carbapenem Resistant ◽

National Healthcare Safety Network ◽

Extended Spectrum ◽

Tract Infections ◽

Healthcare Associated

Objective.To describe the frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections (HAIs) reported by hospitals in the National Healthcare Safety Network (NHSN).Methods.Data are included on HAIs (ie, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections) reported to the Patient Safety Component of the NHSN between January 2006 and October 2007. The results of antimicrobial susceptibility testing of up to 3 pathogenic isolates per HAI by a hospital were evaluated to define antimicrobial-resistance in the pathogenic isolates. The pooled mean proportions of pathogenic isolates interpreted as resistant to selected antimicrobial agents were calculated by type of HAI and overall. The incidence rates of specific device-associated infections were calculated for selected antimicrobial-resistant pathogens according to type of patient care area; the variability in the reported rates is described.Results.Overall, 463 hospitals reported 1 or more HAIs: 412 (89%) were general acute care hospitals, and 309 (67%) had 200-1,000 beds. There were 28,502 HAIs reported among 25,384 patients. The 10 most common pathogens (accounting for 84% of any HAIs) were coagulase-negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%), and Klebsiella oxytoca (2%). The pooled mean proportion of pathogenic isolates resistant to antimicrobial agents varied significantly across types of HAI for some pathogen-antimicrobial combinations. As many as 16% of all HAIs were associated with the following multidrug-resistant pathogens: methicillin-resistant S. aureus (8% of HAIs), vancomycin-resistant Enterococcus faecium (4%), carbapenem-resistant P. aeruginosa (2%), extended-spectrum cephalosporin-resistant K. pneumoniae (1%), extended-spectrum cephalosporin-resistant E. coli (0.5%), and carbapenem-resistant A. baumannii, K. pneumoniae, K. oxytoca, and E. coli (0.5%). Nationwide, the majority of units reported no HAIs due to these antimicrobial-resistant pathogens.

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