scholarly journals Carbapenem-Resistant Enterobacteriaceae Posing a Dilemma in Effective Healthcare Delivery

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 156 ◽  
Author(s):  
Oli ◽  
Itumo ◽  
Okam ◽  
Ezebialu ◽  
Okeke ◽  
...  
Keyword(s):  
Urban Areas ◽  
Klebsiella Oxytoca ◽  
Healthcare Delivery ◽  
Educational Status ◽  
University Teaching ◽  
Diffusion Method ◽  
Female Ratio ◽  
Carbapenem Resistant ◽  
Klebsiella Spp ◽  
Carbapenem Resistant Enterobacteriaceae

The emergence and spread of Carbapenem-resistant Enterobacteriaceae (CRE) is seriously posing threats in effective healthcare delivery. The aim of this study was to ascertain the emergence of CRE at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka. Biological samples were collected from 153 consenting patient from 5 clinics in the hospital. The isolates were identified using standard microbiological protocols. Susceptibility to meropenem was done using Kirby-Bauer disc diffusion method on Mueller Hinton Agar. A total of 153 patients were recruited in this study. About one half of those from rural, 63.64% from Sub-urban and 42.27% from urban areas had significant E. coli and Klebsiella spp infections. The male: female ratio of the Enterobacteriaceae infection was 1:1. Almost as much inpatient as outpatient study participants had the infections. The infections were observed mostly on participants with lower educational status. The unmarried individuals were most infected compared to their married counterparts. Enterobacteriaceae infection rate was 50.98%. Of this, 28.21% had CRE infection while the overall prevalence of the CRE in the studied population was 14.38% (22/153). This study shows that CRE is quickly emerging in both community and hospital environments. Klebsiella spp was the most common CRE in this hospital especially Klebsiella oxytoca. Hospitalization was a strong risk factor in the CRE infections. Rapid and accurate detection is critical for their effective management and control.

Carbapenem-Resistant Enterobacteriaceae Rectal Screening during an Outbreak of New Delhi Metallo-β-Lactamase–Producing Klebsiella pneumoniae at an Acute Care Hospital

2014 ◽  
Vol 35 (4) ◽  
pp. 434-436 ◽  
Author(s):  
Larissa M. Pisney ◽  
M. A. Barron ◽  
E. Kassner ◽  
D. Havens ◽  
N. E. Madinger
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Acute Care Hospital ◽  
University Teaching ◽  
New Delhi ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-β-lactamase–producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

High colonization rate of a novel carbapenem-resistant Klebsiella lineage among migratory birds at Qinghai Lake, China

2019 ◽  
Vol 74 (10) ◽  
pp. 2895-2903 ◽  
Author(s):  
Xiaoping Liao ◽  
Run-Shi Yang ◽  
Jing Xia ◽  
Liang Chen ◽  
Rongmin Zhang ◽  
...  
Keyword(s):  
Susceptibility Testing ◽  
Migratory Birds ◽  
Qinghai Lake ◽  
Molecular Surveillance ◽  
Carbapenem Resistant ◽  
Surrounding Environment ◽  
Rdna Sequencing ◽  
Klebsiella Spp ◽  
Insight Into ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objectives The emergence of carbapenemase-positive Enterobacteriaceae poses a serious threat to public health worldwide. Here we conducted a molecular surveillance study on carbapenem-resistant Enterobacteriaceae (CRE) colonization among migratory birds at Qinghai Lake in China. Methods A total of 420 samples from migratory birds and their surrounding environment were collected at three sites along the Qinghai Lake bird island. Carbapenem-non-susceptible isolates were identified by 16S rDNA sequencing and MALDI-TOF MS. Carbapenemase producers were determined by Carba NP testing. Antimicrobial susceptibility testing, transfer ability and PFGE were also performed, and 46 isolates from different pulsotypes were analysed by WGS. Results Three hundred and fifty isolates were carbapenemase producers based on Carba NP testing, while 233 Klebsiella spp. and 2 Escherichia coli isolates were NDM-5-carriers. PFGE was performed and showed that the isolates were grouped into five pulsotypes; among these, type A was predominant (86.7%, n = 202) and belonged to a novel Klebsiella lineage, ST1697. WGS analysis indicated that ST1697 strains may be a hybrid of the recombination of Klebsiella quasipneumoniae subsp. similipneumoniae and Klebsiella pneumoniae genomes. Conclusions This high frequency of carbapenemase producers in migratory birds is unexpected. These results provide new insight into the spread of antibiotic resistance, and highlight that continued vigilance for MDR carbapenemase-producing Enterobacteriaceae in migratory birds is urgently needed.

scholarly journals oprD Genes Detected in Pseudomonas aeruginosa Isolates from a Teaching Hospital but Lost in a Carbapenem-Resistant Strain

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Eucharia E. Nmema ◽  
Chioma S. Osuagwu ◽  
Eunice N. Anaele
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Teaching Hospital ◽  
Multiple Drug Resistance ◽  
Carbapenem Resistance ◽  
University Teaching ◽  
Diffusion Method ◽  
Multiple Drug ◽  
Disk Diffusion Method ◽  
Chain Reactions ◽  
Carbapenem Resistant

Aims: The aims of the study were to evaluate the multidrug resistance profile and mechanisms of carbapenem resistance in Pseudomonas aeruginosa clinical isolates using phenotypic and genotypic methods. Study Design: A descriptive laboratory based study. Place and Duration of Study: Microbiology Laboratory, Ondo State University of Science and Technology, Okitipupa, and Biotechnology Laboratory, Ladoke Akintola University of Technology, Osogbo, Nigeria, between June 2017 and November 2018. Methodology: Ten P. aeruginosa isolates were recovered from patients at Lagos University Teaching Hospital, and susceptibilities to imipenem (10 µg), meropenem (10 µg) and a panel of antibiotics were performed by the disk diffusion method. Genotypic methods including Polymerase Chain Reactions (PCR) and agarose gel electrophoresis were carried out according to established protocols. oprD and blaIMP gene primers were used for the PCR amplification. Results: Fifty percent (50%) of the isolates showed multiple drug resistance. Four isolates (40%) were carbapenem resistant (CR). oprD gene was detectedin 90% (9/10) of the isolates. 75% (3/4) of CR strains were among the strains showing oprD gene. 25% (1/4) CR strain (PA1421) was oprD negative. Loss or mutation of oprD gene seems to be the mechanism of carbapenem resistance in strain PA1421. Conclusion: Loss or mutation of oprD gene was identified in this study as a mechanism of carbapenem resistance. oprD gene encodes the outer membrane protein (OprD) porin in P. aeruginosa whose deficiency confers resistance to carbapenems, especially imipenem. Surveillance of the antimicrobial susceptibility patterns of P. aeruginosa is of critical importance in understanding new and emerging resistance trends, reviewing antibiotic policies and informing therapeutic options.

Descriptive Study for Detection of Carbapenem Resistant Enterobacteriaceae by the Modified Carbapenem Inactivation Method in a Tertiary Care Hospital of Western Maharashtra

2021 ◽  
Vol 8 (05) ◽  
pp. 261-266
Author(s):  
Suraj Giri ◽  
Sourav Sen ◽  
Mahima Lall
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Test Method ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Care Hospital ◽  
Disk Diffusion Method ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

BACKGROUND In an infection caused by multidrug-resistant Enterobacteriaceae, carbapenems is one the last antibiotics used, but the carbapenemase producing Enterobacteriaceae pose a clinical challenge. A relatively new test which was described few years back known as modified carbapenem inactivation method (mCIM) is used to detect the presence of carbapenemase activity in Gramnegative bacilli. Various studies show this test be to be very sensitive and specific. We aim to study mCIM positivity on samples which are positive by Kirby-Bauer disk diffusion antibiotic sensitivity test method used for detection of carbapenem resistant Enterobacteriaceae (CRE) from clinical specimens. METHODS The study is a cross sectional descriptive study conducted in a tertiary care hospital. Samples received from February 2019 to September 2019 were included in the study. During this period 150 samples were collected which were resistant to meropenem by Kirby-Bauer disk diffusion method. These CREs isolates were further subjected to mCIM and the result was analysed. RESULTS Out of the total 150 CRE isolates which were 100 % resistant to meropenem by the conventional disc diffusion method it is found that mCIM was positive for 148 (98.66 %) isolates and negative for only 02 (1.33 %). Two most common CRE were Klebsiella pneumonia (58 %) and Escherichia coli (32 %). In statistical analysis chi square test revealed statistically significant difference (P < 0.05) in percentage of positivity between the two methods (98.66 % vs 100 %). CONCLUSIONS mCIM is highly sensitive and specific method; however, in practice it showed no added advantage over Kirby-Bauer disk diffusion method in detecting CRE. KEYWORDS Modified Carbapenem Inactivation Method (mCIM), Kirby-Bauer Disk Diffusion Method, Carbapenem Resistant Enterobacteriaceae

scholarly journals Klebsiella pneumoniae carbapenemase production among K. pneumoniae isolates and its concern on antibiotic susceptibility

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Azam Shahi ◽  
Alka Hasani ◽  
Mohammad Ahangarzadeh Rezaee ◽  
Mohammad Asghari Jafarabadi ◽  
Akbar Hasani ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Antibiotic Susceptibility ◽  
University Teaching ◽  
High Rate ◽  
Disk Diffusion ◽  
Teaching Hospitals ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant

The emergence of Klebsiella pneumoniae carbapenemase (KPC) resistance has led to the countdown of activity of carbapenems, which were considered as drugs of last resort for infections caused by Enterobacteriaceae. The aims of the present study were the detection of KPC-production among K. pneumoniae isolates, select the appropriate method for its detection and assess the consequence of KPC production on the antibiotics susceptibility. One hundred and four non-duplicated K. pneumoniae isolates were collected from University teaching hospitals of Tabriz, Iran. The disk diffusion, E-test, and Modified Hodge test were performed for the determination of antibiotic susceptibility pattern, Minimum Inhibitory Concentrations (MICs) determination and the production of carbapenemase, respectively. BlaKPC-2 gene was detected by using PCR. High levels of resistance were observed towards co-trimoxazole (69.2%), followed by cefazolin (66.3%), ceftriaxone (65.4%), ofloxacin and ciprofloxacin (54.8%), gentamicin (50%), and amikacin (39.4%). According to the disk diffusion method, the frequency of imipenem and meropenem resistance was 31.7% and 32.7%, respectively. Colistin was the most effective antibiotic among panels of antibiotics tested. Imipenem MICs range, MIC50 and MIC90 were 0.19-32 μg/ml, 4 μg/ml, and 16 μg/ml, respectively. Modified Hodge test was positive in 24 (63.2%) isolate however, blaKPC-2 gene was detected in 8 (21.1%) carbapenem- resistant isolates. Results of the present study revealed a high rate of carbapenem- resistance in K. pneumoniae by phenotypic method, however the presence of one of the molecular, namely blaKPC-2 was not found as predominant cause. Therefore, their reliable detection should be the first priority to combat the infections. Being a simple test, the imipenem disk diffusion could be considered as an appropriate method for the detection of carbapenem-resistant isolates in the routine diagnosis.

scholarly journals ESBL Production Among E. coli and Klebsiella spp. Causing Urinary Tract Infection: A Hospital Based Study

2017 ◽  
Vol 11 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Pooja Shakya ◽  
Dhiraj Shrestha ◽  
Elina Maharjan ◽  
Vijay K. Sharma ◽  
Rabin Paudyal
Keyword(s):  
Clavulanic Acid ◽  
Treatment Options ◽  
Klebsiella Oxytoca ◽  
Tertiary Hospital ◽  
Diffusion Method ◽  
Disc Diffusion ◽  
Biochemical Tests ◽  
E Coli ◽  
Significant Bacteriuria ◽  
Klebsiella Spp

Introduction:Increase in extended-spectrum β-lactamases (ESBL) producing microbes in recent years has led to limitations of treatment options. This study aimed to assess the prevalence of ESBL producingE. coliandKlebsiellaspp. at a tertiary hospital in Nepal.Methods:A total of 2209 non-repetitive mid-stream urine (MSU) samples were collected during the study period (March to September 2014). Identification of the isolates was done by Gram's staining followed by biochemical tests. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines, 2013. ESBL screening amongE. coliandKlebsiellaspp. isolates were done using ceftriaxone, cefotaxime, ceftazidime and cefpodoxime. The confirmation was done by phenotypic disc diffusion test (combined disc method) using ceftazidime (30µg) and ceftazidime plus clavulanic acid (30/10µg), and cefotaxime (30µg) and cefotaxime plus clavulanic acid (30/10µg) disc as per CLSI guidelines.Results:A total of 451 samples showed significant bacteriuria with 365 (80.9%)E. coli, 17 (3.8%)Klebsiella pneumoniaeand 3 (0.7%)Klebsiella oxytoca. Of 451 isolates, 236 (52.3%) were found MDR strains. By combined disk test, 33 (91.7%)E. coliand 3 (8.3%)Klebsiellaspp. were found ESBL producers.Conclusion:Higher prevalence of ESBL producingE. coliandKlebsiellaspp. was observed warranting prompt need of surveillance for effective management of such MDR strains.

scholarly journals Prevalence of carbapenemase production in Pseudomonas aeruginosa isolates causing clinical infections in Lagos University Teaching Hospital, Nigeria

2021 ◽  
Vol 22 (4) ◽  
pp. 498-503
Author(s):  
A.O. Ettu ◽  
B.A. Oladapo ◽  
O.O. Oduyebo
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Teaching Hospital ◽  
Dipicolinic Acid ◽  
Phenylboronic Acid ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
University Teaching ◽  
Diffusion Method ◽  
Carbapenem Resistant ◽  
Mueller Hinton

Background: Pseudomonas aeruginosa has been highly associated with carbapenem resistance in which carbapenemases has been suggested to be a major contributory factor. Hence the objective of this study was to phenotypically detect KPC-type carbapenemase, metallo-β-lactamase and OXA-48 carbapenemase production in clinical isolates of P. aeruginosa in Lagos University Teaching Hospital (LUTH), NigeriaMethodology: One hundred and seventy-one P. aeruginosa isolates consecutively recovered from clinical specimens of patients with infections at the Medical Microbiology and Parasitology laboratory of the hospital were identified using MicrobactTM 24E kit. Preliminary screening for carbapenem resistance was determined by the disc diffusion method on Mueller-Hinton agar using single discs of meropenem and imipenem. Phenotypic detection of carbapenemase production among carbapenem-resistant isolates was performed by the combination disc test of meropenem-phenylboronic acid (MRPBO) and meropenem-dipicolinic acid (MRPDP) as recommended by EUCAST 2013 guideline. Results: Out of the 171 P. aeruginosa isolates, 35 (20.5%) were carbapenem non-susceptible (resistant) while carbapenemase production was detected in 27 (77.1%) of these carbapenem resistant isolates, and no enzyme was detected in 8 (22.9%). Of the 27 carbapenemase producing isolates, 22 (81.5%) produced MBL, 1 (3.7%) produced KPC, while 4 (14.8%) produced both KPC and MBL enzymes. Conclusion: This study revealed that carbapenem resistance among P. aeruginosa clinical isolates in our institution is gradually increasing. The mechanism for this rise is associated with carbapenemases, with MBL being the major carbapenemase involved. There is the need to ensure strict compliance with the LUTH infection control guidelines in order to check the rising incidence of infection caused by carbapenem resistant P. aeruginosa.   French title: Prévalence de la production de carbapénémases dans les isolats de Pseudomonas aeruginosa causant des infections cliniques à l'hôpital universitaire de Lagos, Nigéria   Contexte: Pseudomonas aeruginosa a été fortement associé à la résistance aux carbapénèmes dans laquelle les carbapénèmases ont été suggérées comme étant un facteur contributif majeur. Par conséquent, l'objectif de cette étude était de détecter phénotypiquement la production de carbapénémase de type KPC, de métallo-β-lactamase et de carbapénémase OXA-48 dans des isolats cliniques de P. aeruginosa au Lagos University Teaching Hospital (LUTH), Nigeria. Méthodologie: Cent soixante et onze isolats de P. aeruginosa récupérés consécutivement à partir d'échantillons cliniques de patients infectés au laboratoire de microbiologie médicale et de parasitologie de l'hôpital ont été identifiés à l'aide du kit MicrobactTM 24E. Le dépistage préliminaire de la résistance aux carbapénèmes a été déterminé par la méthode de diffusion sur disque sur gélose Mueller-Hinton en utilisant des disques uniques de méropénème et d'imipénème. La détection phénotypique de la production de carbapénèmes parmi les isolats résistants aux carbapénèmes a été réalisée par le test de disque combiné d'acide méropénème-phénylboronique (MRPBO) et d'acide méropénème-dipicolinique (MRPDP) tel que recommandé par la directive EUCAST 2013. Résultats: Sur les 171 isolats de P. aeruginosa, 35 (20,5%) étaient des carbapénèmes non sensibles (résistants) tandis que la production de carbapénèmes a été détectée dans 27 (77,1%) de ces isolats résistants aux carbapénèmes, et aucune enzyme n'a été détectée dans 8 (22,9%). Sur les 27 isolats producteurs de carbapénémases, 22 (81,5%) produisaient des MBL, 1 (3,7%) produisaient des KPC, tandis que 4 (14,8%) produisaient à la fois des enzymes KPC et MBL. Conclusion: Cette étude a révélé que la résistance aux carbapénèmes parmi les isolats cliniques de P. aeruginosa dans notre institution augmente progressivement. Le mécanisme de cette augmentation est associé aux carbapénémases, la MBL étant la principale carbapénémase impliquée. Il est nécessaire de garantir le strict respect des directives de contrôle des infections LUTH afin de contrôler l'incidence croissante des infections causées par P. aeruginosa résistant aux carbapénèmes.

scholarly journals Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital

2020 ◽  
Vol 3 (4) ◽  
pp. 295-301
Author(s):  
L.G. Boronina ◽  
◽  
E.V. Samatova ◽  
S.M. Blinova ◽  
M.P. Kukushkina ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Pediatric Hospital ◽  
Mechanisms Of Resistance ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Phenotypic Methods ◽  
Carbapenem Resistant Enterobacteriaceae

Aim: to define the incidence of carbapenem-resistant Enterobacteriaceae in the bioassay of hospitalized children. Patients and Methods: From January to December 2019, 940 strains of gram-negative bacteria were isolated from clinical material of 900 patients. Antibiotic susceptibility testing was conducted using the disk diffusion method; SENSITITRE and Phoenix M50 analyzers used «CHROMagarTM KPC» medium. Also, Carbapenem Inactivation Method was used to detect the carbapenemase activity. Results: the species composition of carbapenem-resistant Enterobacteriaceae included: Pseudomonas aeruginosa (n=55), Acinnetobacter baumannii (n=22), Escherichia coli (n=2), Klebsiella pneumoniae (n=40), Klebsiella oxytoca (n=1), Enterobacter cloacae (n=7), Serratia marcescens (n=2), Proteus mirabilis (n=2), Pseudomonas putida (n=1). 12.1% of all Enterobacterales isolates and 29.4% Klebsiella pneumoniae strains were resistant to ertapenem; 17.2% of Enterobacteriaceae and 20% of K. pneumoniae strains were resistant to imipenem and meropenem. 50.9% of Pseudomonas aeruginosa strains were resistant to meropenem and imipenem, and 45% — to doripenem. Acinetobacter baumannii strains resistant to meropenem — 66.6%, imipenem — 63.6%, doripenem — 83.3%. In 30.4% of P. aeruginosa and A. baumannii strains, carbapenemase activity was not detected, which indicated other mechanisms of resistance to carbapenem. Conclusion: in most cases, phenotypic methods only allow to suspect the presence of certain mechanisms of acquired resistance. However, since the main, most common mechanism is the production of hydrolytic enzymes, the identification of mechanisms of resistance to carbapenems should be precisely directed at this. At present, in addition to phenotypic methods, it is optimal to use molecular methods, in particular, realtime PCR, to effectively monitor the distribution of carbapenemase producers. KEYWORDS: Enterobacterales, non-fermenting gram-negative bacteria, carbapenemases, children, infection. FOR CITATION: Boronina L.G., Samatova E.V., Blinova S.M. et al. Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital. Russian Journal of Woman and Child Health. 2020;3(4):295–301. DOI: 10.32364/2618-8430-2020-3-4-295-301.

scholarly journals 533. Impact of Different Definitions on Reported Rates of Carbapenem-Resistant Enterobacteriaceae (CRE)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S256-S256
Author(s):  
Catherine Passaretti ◽  
Anupama Neelakanta ◽  
Jessica Layell ◽  
Eileen Campbell ◽  
Shelley Kester
Keyword(s):  
Healthcare Facility ◽  
Healthcare Associated Infection ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Trends Over Time ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
Klebsiella Spp ◽  
Over Time ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Different definitions exist for tracking and trending rates of hospital-acquired Carbapenem-resistant Enterobacteriaceae (CRE). National Health Safety Network (NHSN) allows for Laboratory Identified Event (LabID) and Healthcare-associated infection (HAI) surveillance reporting for CRE. Our facility developed an internal definition for CRE prior to release of the NHSN modules that differs from the CDC definitions in that patients colonized or infected with CRE identified on hospital day 1 or 2 who had a hospitalization within the past four weeks are considered community-onset healthcare facility acquired (COHCFA) and are included in our HA definition. In addition, by our definition once a patient develops CRE any subsequent positive cultures for the same organism are not considered new events. Methods All CRE cultures at our facility were reviewed by an infection preventionist and hospital epidemiologist who categorized each culture as hospital acquired by our internal HA definition, NHSN LabID definition and NHSN HAI definition. Results from each method of surveillance were compiled and compared as were trends of HA CRE over time by each definition. Results 590 patients with 975 clinical cultures for Carbapenem-resistant Klebsiella spp., Enterobacter spp and E. coli were reviewed from January 2012 to March 2019. 297 cultures met our internal definition for HA CRE compared with 302 by NHSN LabID and 189 by NHSN HAI surveillance. Sixty-one (21%) of HA cases by our definition were COHCFA. 259 patients had multiple CRE cultures and 1 patient had 22 cultures with the same CRE organism between 2014 and 2019 and met for 5 lab ID events and 5 NHSN HAI events. All 3 tests agreed that a culture was HA in 140 instances (14%) and all 3 agreed that a culture was not HA in 589 instances (60%). At least one definition yielded a discordant result in 246 cultures (25%). Trends over time were compared between the definitions. While the number of HA cases varied based on the definition used, overall trends over time were similar regardless of the definition utilized. (Figure 2) Conclusion Regardless of the definition used for surveillance of CRE, trends over time are similar. Consideration should be given to monitoring COHCFA cases in addition to those acquired on or after hospital day 3. Disclosures All authors: No reported disclosures.

Comparison of the in vitro activities of ceftazidime/avibactam with other drugs used to treat carbapenem-resistant Enterobacteriaceae

2020 ◽  
Vol 18 ◽  
Author(s):  
Wesam Hatem Amer ◽  
Samah Abdel Rahman Elshweikh ◽  
Nahed Ahmad Hablas ◽  
Karim Abdelfattah Montasser ◽  
Haidy Samir Khalil
Keyword(s):  
Good Choice ◽  
Predictive Values ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Polymerase Chain ◽  
Hospital Acquired ◽  
Ideal Method ◽  
Klebsiella Spp ◽  
Carbapenem Resistant Enterobacteriaceae

Background & Objective:: Our goal was to compare the in vitro activities of ceftazidime/avibactam (CZA) to those observed in response to other drugs used to treat carbapenem-resistant Enterobacteriaceae (CRE). Methods:: Bacterial isolates collected from intensive care unit patients with hospital-acquired infections were identified using the VITEK 2TMCompact 15. Susceptibility testing for Escherichia coli and Klebsiella spp. was performed using Kirby- Bauer disk diffusion and the VITEK2 system. Minimum inhibitory concentration (MIC) E-test strips were used to examine susceptibility to fosfomycin, colistin, and CZA. Detection of carbapenemase in isolates of Enterobacteriaceae was performed using the modified carbapenem inactivation method (mCIM) and multiplex polymerase chain reaction. Results:: A full 62.5% of the Enterobacteriaceae isolates were CRE. The sensitivity and specificity of mCIM were 98.3% and 100%, respectively, with positive predictive and negative predictive values and accuracy at 100%, 97.3%, and 98.96%, respectively. The most prevalent of the carbapenemase genes was blaKPC which was detected in 46.7% of all isolates and in 83.3% of those identified as Klebsiella pneumoniae. CRE were most sensitive to colistin (96.7%), CZA (80%) and tigecycline (71.7%) (p<0.001). The MIC50 for CZA (≤0.016 μg/mL) was the lowest of all the drugs evaluated, followed by colistin (1 μg/mL) and tigecycline (2 μg/mL). All metallo-ß-lactamase-negative isolates were sensitive to CZA. Conclusions:: mCIM is sensitive, specific, inexpensive and easy to perform; as such, it an ideal method for identification of carbapenem-resistant strains. Our results suggest that CZA may be a good choice for treating infections with CRE if therapeutic options are limited.

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