Outcomes and genetic relatedness of carbapenem-resistant enterobacteriaceae at detroit medical center

Dror Marchaim, Teena Chopra, Federico Perez, Kayoko Hayakawa, Paul R. Lephart, Suchitha Bheemreddy, Christopher Blunden, Andrea M. Hujer, Susan Rudin, Maryann Shango, Michelle Campbell, Jastin Varkey, Jessica Slim, Farah Ahmad, Diixa Patel, Ting Yi Chen, Jason M. Pogue, Hossein Salimnia, Sorabh Dhar, Robert A. BonomoKeith S. Kaye

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)861-871
Number of pages11
JournalInfection Control and Hospital Epidemiology
Volume32
Issue number9
DOIs
StatePublished - Sep 1 2011

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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