PDF(Pubmed)
Abstract：
Pseudomonas aeruginosa harboring Verona Integron-encoded metallo-β-lactamase enzymes (VIM-CRPA) have been associated with infection outbreaks in several parts of the world. In the US, however, VIM-CRPA remain rare. Starting in December 2018, we identified a cluster of cases in our institution. Herein, we present our epidemiological investigation and strategies to control/manage these challenging infections. This study was conducted in a large academic healthcare system in Miami, FL, between December 2018 and January 2022. Patients were prospectively identified via rapid molecular diagnostics when cultures revealed carbapenem-resistant P. aeruginosa. Alerts were received in real time by the antimicrobial stewardship program and infection prevention teams. Upon alert recognition, a series of interventions were performed as a coordinated effort. A retrospective chart review was conducted to collect patient demographics, antimicrobial therapy, and clinical outcomes. Thirty-nine VIM-CRPA isolates led to infection in 21 patients. The majority were male (76.2%); the median age was 52 years. The majority were mechanically ventilated (n = 15/21; 71.4%); 47.6% (n = 10/21) received renal replacement therapy at the time of index culture. Respiratory (n = 20/39; 51.3%) or bloodstream (n = 13/39; 33.3%) were the most common sources. Most infections (n = 23/37; 62.2%) were treated with an aztreonam-avibactam regimen. Six patients (28.6%) expired within 30 days of index VIM-CRPA infection. Fourteen isolates were selected for whole genome sequencing. Most of them belonged to ST111 (12/14), and they all carried blaVIM-2 chromosomally. This report describes the clinical experience treating serious VIM-CRPA infections with either aztreonam-ceftazidime/avibactam or cefiderocol in combination with other agents. The importance of implementing infection prevention strategies to curb VIM-CRPA outbreaks is also demonstrated.
摘要：
携带维罗纳整合子编码的金属-β-内酰胺酶（VIM-CRPA）的铜绿假单胞菌与世界几个地区的感染暴发有关。在美国,然而,VIM-CRPA仍然很少见。从2018年12月开始，我们确定了我们机构中的一组病例。在这里，我们介绍了我们的流行病学调查以及控制/管理这些具有挑战性的感染的策略.这项研究是在迈阿密的一个大型学术医疗系统中进行的，FL,2018年12月至2022年1月。当培养物显示耐碳青霉烯铜绿假单胞菌时，通过快速分子诊断对患者进行前瞻性鉴定。抗生素管理计划和感染预防小组实时收到警报。警报识别后，作为一项协调努力,我们进行了一系列干预.进行了回顾性图表审查，以收集患者的人口统计数据，抗菌治疗,和临床结果。39株VIM-CRPA分离株导致21例患者感染。大多数为男性（76.2％）；中位年龄为52岁。大多数进行了机械通气（n=15/21；71.4％）；47.6％（n=10/21）在索引培养时接受了肾脏替代疗法。呼吸（n=20/39；51.3％）或血液（n=13/39；33.3％）是最常见的来源。大多数感染（n=23/37；62.2％）采用氨曲南-阿维巴坦方案治疗。6例患者（28.6%）在VIM-CRPA感染指数30天内过期。选择14个分离株用于全基因组测序。他们中的大多数属于ST111（12/14），他们都携带blaVIM-2染色体.本报告描述了使用氨曲南-头孢他啶/阿维巴坦或头孢多罗与其他药物联合治疗严重VIM-CRPA感染的临床经验。还证明了实施感染预防策略以遏制VIM-CRPA爆发的重要性。
