TY - JOUR
T1 - Outcomes and genetic relatedness of carbapenem-resistant enterobacteriaceae at detroit medical center
AU - Marchaim, Dror
AU - Chopra, Teena
AU - Perez, Federico
AU - Hayakawa, Kayoko
AU - Lephart, Paul R.
AU - Bheemreddy, Suchitha
AU - Blunden, Christopher
AU - Hujer, Andrea M.
AU - Rudin, Susan
AU - Shango, Maryann
AU - Campbell, Michelle
AU - Varkey, Jastin
AU - Slim, Jessica
AU - Ahmad, Farah
AU - Patel, Diixa
AU - Chen, Ting Yi
AU - Pogue, Jason M.
AU - Salimnia, Hossein
AU - Dhar, Sorabh
AU - Bonomo, Robert A.
AU - Kaye, Keith S.
PY - 2011/9
Y1 - 2011/9
N2 - Background. Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging in hospitals in the United States and are posing a significant threat. To better understand the transmission dynamics and the acquisition of resistant strains, a thorough analysis of epidemiologic and molecular characteristics was performed. Methods. CRE isolated at Detroit Medical Center were analyzed from September 2008 to September 2009. bla KPC genes were investigated by polymerase chain reaction (PCR), and repetitive extragenic palindromic PCR (rep-PCR) was used to determine genetic similarity among strains. Epidemiologic and outcomes analyses were performed. Results. Ninety-two unique patient CRE isolates were recovered. Sixty-eight strains (74%) were Klebsiella pneumoniae, 7 were Klebsiella oxytoca, 15 were Enterobacter species, and 2 were Escherichia coli. Fifteen isolates (16%) were resistant to colistin, 14 (16%) were resistant to tigecycline, and 2 were resistant to all antimicrobials tested. The mean ± standard deviation age of patients was 63±2 years. Sixty patients (68%) were admitted to the hospital from long-term care facilities. Only 70% of patients received effective antimicrobial therapy when infection was suspected, with a mean time to appropriate therapy of 120±23 hours following sample culturing. The mean length of hospitalization after sample culturing was 18.6±2.5 days. Of 57 inpatients, 18 (32%) died in the hospital. Independent predictors for mortality were intensive care unit stay (odds ratio [OR], 15.8; Pp.003) and co-colonization with CRE and either Acinetobacter baumannii or Pseudomonas aeruginosa (OR, 17.2; Pp.006). Among K. pneumoniae CRE, rep-PCR revealed 2 genetically related strains that comprised 70% and 20% of isolates, respectively. Conclusions. In this large U.S. cohort of patients with CRE infection, which reflects the modern continuum of medical care, cocolonization with CRE and A. baumannii or P. aeruginosa was associated with increased mortality. Two predominant clones of K. pneumonia accounted for the majority of cases of CRE infection.
AB - Background. Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging in hospitals in the United States and are posing a significant threat. To better understand the transmission dynamics and the acquisition of resistant strains, a thorough analysis of epidemiologic and molecular characteristics was performed. Methods. CRE isolated at Detroit Medical Center were analyzed from September 2008 to September 2009. bla KPC genes were investigated by polymerase chain reaction (PCR), and repetitive extragenic palindromic PCR (rep-PCR) was used to determine genetic similarity among strains. Epidemiologic and outcomes analyses were performed. Results. Ninety-two unique patient CRE isolates were recovered. Sixty-eight strains (74%) were Klebsiella pneumoniae, 7 were Klebsiella oxytoca, 15 were Enterobacter species, and 2 were Escherichia coli. Fifteen isolates (16%) were resistant to colistin, 14 (16%) were resistant to tigecycline, and 2 were resistant to all antimicrobials tested. The mean ± standard deviation age of patients was 63±2 years. Sixty patients (68%) were admitted to the hospital from long-term care facilities. Only 70% of patients received effective antimicrobial therapy when infection was suspected, with a mean time to appropriate therapy of 120±23 hours following sample culturing. The mean length of hospitalization after sample culturing was 18.6±2.5 days. Of 57 inpatients, 18 (32%) died in the hospital. Independent predictors for mortality were intensive care unit stay (odds ratio [OR], 15.8; Pp.003) and co-colonization with CRE and either Acinetobacter baumannii or Pseudomonas aeruginosa (OR, 17.2; Pp.006). Among K. pneumoniae CRE, rep-PCR revealed 2 genetically related strains that comprised 70% and 20% of isolates, respectively. Conclusions. In this large U.S. cohort of patients with CRE infection, which reflects the modern continuum of medical care, cocolonization with CRE and A. baumannii or P. aeruginosa was associated with increased mortality. Two predominant clones of K. pneumonia accounted for the majority of cases of CRE infection.
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U2 - 10.1086/661597
DO - 10.1086/661597
M3 - Article
C2 - 21828966
AN - SCOPUS:80051772022
SN - 0899-823X
VL - 32
SP - 861
EP - 871
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 9
ER -