Carbapenem resistant Enterobacteriaceae

耐碳青霉烯类肠杆菌科
  • 文章类型: Journal Article
    耐碳青霉烯类肠杆菌(CRE)是人类主要的病原菌,这些导致大量难以治疗的感染。异基因造血干细胞移植(AHSCT)受体高度暴露于这些类型的细菌。我们研究的目的是调查AHSCT患者CRE定植的患病率,并确定编码碳青霉烯耐药的基因。2015年1月至2019年12月进行的一项回顾性研究涉及55例CRE菌株定植的患者。我们根据欧洲抗菌药物敏感性测试委员会(EUCAST)和碳青霉烯类耐药基因,通过PCR测定编码最常见β-内酰胺酶的基因,即blages,blaKPC,blaimi,blaNDM,BlaVIM,blaIMP和blaOXA-48.在55例患者中记录了81次CRE定植事件,主要患有急性白血病(30%)和再生障碍性贫血(26%)。在80例发作中记录了住院史。之前的抗生素治疗,重度中性粒细胞减少症和糖皮质激素治疗分别占94%,76%和58%的病例。在55名患者中,6例患者(11%)发生CRE感染.在90%的病例中,负责定殖的CRE是碳青霉烯酶生产者。它们主要属于肺炎克雷伯菌(61/81)和大肠杆菌(10/81)。厄他培南的抗生素耐药率为100%,53%为亚胺培南,42%为阿米卡星,88%的环丙沙星和27%的磷霉素。分子研究表明blaOXA-48基因最常见(60.5%),其次是blaNDM(58%)。35个(43%)菌株是碳青霉烯酶的共同生产者。在我们的研究中,我们报告在我们中心的AHSCT受者中CRE肠道定植率很高.
    Carbapenem resistant Enterobacteriaceae (CRE) are major human pathogens because, these cause high number of difficult-to-treat infections. Allogeneic hematopoietic stem cell transplant (AHSCT) recipients are highly exposed to these type of bacteria. The aim of our study was to investigate prevalence of CRE colonization in AHSCT patients and to determine genes encoding carbapenem resistance. A retrospective study conducted between January 2015 and December 2019, involved 55 patients colonized with CRE strains. We determined the rate of antibiotic resistance according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the carbapenem resistance genes by PCR assays for genes encoding most frequent β-lactamases namely, blaGES, blaKPC, blaIMI, blaNDM, blaVIM, blaIMP and blaOXA-48. Eighty-one episodes of CRE colonization were recorded in 55 patients, mainly suffering from acute leukaemia (30%) and aplastic anemia (26%). History of hospitalization was noted in 80 episodes. Prior antibiotic treatment, severe neutropenia and corticosteroid therapy were respectively found in 94%, 76% and 58% of cases. Among the 55 patients, six patients (11%) developed a CRE infection. The CRE responsible for colonization were carbapenemase producers in 90% of cases. They belonged mostly to Klebsiella pneumoniae (61/81) and Escherichia coli species (10/81). Antibiotic resistance rates were 100% for ertapenem, 53% for imipenem, 42% for amikacin, 88% for ciprofloxacin and 27% for fosfomycin. Molecular study showed that blaOXA-48 gene was the most frequent (60.5%), followed by blaNDM (58%). Thirty-five (43%) strains were co-producers of carbapenemases. In our study, we report a high rate of CRE intestinal colonization in AHSCT recipients of our center.
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  • 文章类型: Journal Article
    背景:患有血液病的中性粒细胞减少患儿与碳青霉烯类耐药肠杆菌科(CRE)血流感染(BSI)或定植的发病率较高相关。但是关于临床特征仍然不清楚,抗菌敏感性,以及这些患者的CRE-BSI结果。我们旨在确定CRE-BSI引起的后续菌血症和临床结局的潜在危险因素。
    方法:在2008年至2020年之间,纳入了2,465名连续的中性粒细胞减少儿童。CRE-BSI的发生率和特征在CRE-定植者与非定植者中进行了探讨。进行生存分析,并评估CRE-BSI和30天死亡率的危险因素。
    结果:在59/2465(2.39%)中性粒细胞减少儿童中发现了CRE携带者,在19/59(32.2%)中发现了CRE-BSI,而12/2406(0.5%)的非携带者出现CRE-BSI(P<0.001)。CRE-BSI患者的30天生存概率显着低于非BSI患者(73.9%vs.94.9%,P=0.050)。此外,CRE-BSI患者的30天生存概率在CRE携带者与非携带者中也较差(49.7%vs.91.7%,P=0.048)。替加环素和阿米卡星对所有分离的菌株均表现出令人满意的抗菌活性。大肠杆菌(26.3%)的氟喹诺酮敏感性较低,而阴沟肠杆菌和其他CRE菌株(91.2%)的敏感性令人满意。CRE-BSI伴肠黏膜损伤是影响30天生存概率的独立危险因素(均P<0.05),而联合抗生素治疗和持续时间较长的中性粒细胞减少更容易发生CRE-BSI(P<0.05)。
    结论:CRE-定植者易于发生随后的BSI,CRE-BSI被认为是中性粒细胞减少儿童高死亡率的独立预测因素。此外,由于不同CRE菌株患者的特点不同,应采用个体化抗菌治疗。
    Neutropenic children with hematological diseases were associated with higher morbidity of carbapenem-resistant enterobacteriaceae (CRE) blood-stream infection (BSI) or colonization. But it was still murky regarding clinical characteristics, antimicrobial susceptibility, and outcomes of CRE-BSI in these patients. We aimed to identify the potential risk factors for subsequent bacteremia and clinical outcome caused by CRE-BSI.
    Between 2008 and 2020, 2,465 consecutive neutropenic children were enrolled. The incidence and characteristics of CRE-BSI were explored in CRE-colonizers versus non-colonizers. Survival analysis was performed and risk factors for CRE-BSI and 30-day mortality were evaluated.
    CRE-carriers were identified in 59/2465 (2.39%) neutropenic children and19/59 (32.2%) developed CRE-BSI, while 12/2406 (0.5%) of non-carriers developed CRE-BSI (P < 0.001). The 30-day survival probability was significantly lower in patients with CRE-BSI than in non-BSI (73.9% vs. 94.9%, P = 0.050). Moreover, the 30-day survival probability of patients with CRE-BSI was also poorer in CRE-carriers versus non-carriers (49.7% vs. 91.7%, P = 0.048). Tigecycline and amikacin exhibited satisfactory antimicrobial activity against all isolated strains. Fluoroquinolone sensitivity was lower in E. coli (26.3%) strains versus satisfactory susceptibility of E. cloacae and other CRE-strains (91.2%). CRE-BSI accompanying intestinal mucosal damage were independent risk factors for 30-day survival probability (both P < 0.05), while combined antibiotic therapy and longer duration of neutropenia were more prone to developed CRE-BSI (P < 0.05).
    CRE-colonizers were prone to subsequent BSI and CRE-BSI was regarded as an independent predictor predisposing to high mortality in neutropenic children. Moreover, individualized antimicrobial therapy should be adopted due to different features of patients with separate CRE strains.
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  • 文章类型: Observational Study
    背景:耐碳青霉烯类肠杆菌科(CRE)感染的发生率在世界范围内正在增加。由于缺乏替代抗生素,预防感染传播是CRE感染管理策略的一部分。与接受患者临床状况规定的常规培养后的接触隔离相比,通过主动监测与接触隔离相结合的早期发现CRE更为合适。
    目的:确定积极的CRE监测是否会降低儿科重症监护病房(PICU)的CRE感染率。
    方法:回顾性观察性研究于2013年7月至2015年6月在三级护理教学儿童医院的10张病床的PICU进行。除稳定的术后患者外,所有PICU患者均发送了用于CRE的直肠拭子。直肠拭子阳性患者遵循接触隔离预防措施。计算并比较CRE定植和感染率。
    结果:共发送了1022例患者的1262个直肠拭子。CRE定植率为19.5%。干预后,ICU获得性CRE定植下降36%,ICU获得性CRE感染率下降100%,两者均显示出显着下降(p<0.0001)。
    结论:在适当情况下积极的CRE监测和接触隔离制度有助于降低PICU中CRE定植和感染率。
    The incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient\'s clinical condition.
    To determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU).
    Retrospective observational study done in the 10-bed PICU of a tertiary care teaching children\'s hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared.
    Total of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p ​< ​0.0001).
    Active CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.
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  • 文章类型: Journal Article
    背景:耐碳青霉烯类肠杆菌(CRE)定植是CRE感染的危险因素。CRE感染导致肝硬化患者死亡率增加。然而,关于无肝移植的肝病患者CRE定植的患病率和危险因素的数据很少.本研究旨在调查患病率,肝病患者CRE粪便携带的危险因素和分子流行病学特征。
    方法:从2020年12月至2021年4月收集574例成人肝病住院患者的粪便标本。使用选择性显色琼脂培养基筛选CRE,并通过基质辅助激光解吸/电离飞行时间质谱(MALDI-TOFMS)鉴定。使用肉汤微量稀释法确定抗菌药敏感性。通过聚合酶链反应(PCR)和DNA测序来表征碳青霉烯酶基因。对耐碳青霉烯类肺炎克雷伯菌(CR-KPN)分离株和耐碳青霉烯类大肠杆菌(CR-ECO)分离株进行多位点序列分型(MLST)。
    结果:收集了574例肝病患者的粪便标本总数(732份)。从39例患者中分离出43株不重复CRE菌株,携带率为6.79%(39/574)。慢性急性肝衰竭(ACLF)患者的携带率为15.60%(17/109)。多因素分析显示ACLF(P=0.018),过去3个月内肺部感染史(P=0.001)和过去3个月内使用第三代头孢菌素/β-内酰胺酶抑制剂(P=0.000)是肝病患者CRE定植的独立危险因素.肺炎克雷伯菌(KPN)(51.28%)和大肠埃希菌(ECO)(30.77%)是这些患者的主要菌株。除多粘菌素B和替加环素外,所有CRE菌株对大多数抗菌剂均显示出高抗性。大多数(83.72%,36/43)的CRE携带碳青霉烯酶基因。blaKPC-2是主要的碳青霉烯酶基因。KPN的分子流行病学以ST11为主,而ECO的STs分散。
    结论:本研究显示,ACLF患者的CRE粪便携带率高于无肝衰竭患者。ACLF,过去3个月内肺部感染病史和过去3个月内使用第三代头孢菌素/β-内酰胺酶抑制剂是肝病患者CRE定植的独立危险因素.应定期对肝病住院患者进行CRE筛查,以限制CRE菌株的传播。
    BACKGROUND: Carbapenem resistant Enterobacteriaceae (CRE) colonization is a risk factor for CRE infection. CRE infection results in an increase in mortality in patients with cirrhosis. However, minimal data regarding the prevalence and the risk factors of CRE colonization in patients with liver disease yet without liver transplantation are available. The present study aimed to investigate the prevalence, risk factors and molecular epidemiology characteristics of CRE fecal carriage among patients with liver disease.
    METHODS: Stool specimens from 574 adult inpatients with liver disease were collected from December 2020 to April 2021. CRE were screened using selective chromogenic agar medium and identified by the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined using the broth microdilution method. Carbapenemase genes were characterized by polymerase chain reaction (PCR) and DNA sequencing. Multilocus sequence typing (MLST) was performed for Carbapenem Resistant Klebsiella pneumoniae (CR-KPN) isolates and Carbapenem Resistant Escherichia Coli (CR-ECO) isolates.
    RESULTS: The total number of stool specimens (732) were collected from 574 patients with liver disease. 43 non-duplicated CRE strains were isolated from 39 patients with a carriage rate of 6.79% (39/574). The carriage rate was 15.60% (17/109) in patients with acute-on-chronic liver failure (ACLF). Multivariate analysis indicated that ACLF (P = 0.018), the history of pulmonary infection within past 3 months (P = 0.001) and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months (P = 0.000) were independent risk factors of CRE colonization in patients with liver disease. Klebsiella Pnuemoniae (KPN) (51.28%) and Escherichia coli (ECO) (30.77%) were main strains in these patients. All CRE strains showed high resistance to most antimicrobials except for polymyxin B and tigecycline. Most (83.72%, 36/43) of the CRE carried carbapenemase genes. blaKPC-2 was the major carbapenemase gene. The molecular epidemiology of KPN were dominated by ST11, while the STs of ECO were scattered.
    CONCLUSIONS: The present study revealed that CRE fecal carriage rates were higher in patients with ACLF than in patients without liver failure. ACLF, the history of pulmonary infection within past 3 months and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months were independent risk factors of CRE colonization in patients with liver disease. Regular CRE screening for hospitalized patients with liver disease should be conducted to limit the spread of CRE strain.
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  • 文章类型: Journal Article
    肠杆菌科由于碳青霉烯酶(CPs)和超广谱β-内酰胺酶(ESBL)的广泛产生和传播而被世界卫生组织归类为严重耐药细菌。本研究旨在确定产生CP和ESBL的肠杆菌科细菌的患病率,以及他们的抗生素敏感性。为此,我们进行了一项以医院为基础的研究,纳入了384例细菌感染患者.按照标准微生物方案进行样本的收集和处理。将样品接种在琼脂培养基板上以获得细菌生长物,如果它们对任何细菌生长呈阳性,抗生素药敏试验使用纸片扩散法进行,以检查其抗生素药敏模式.使用双盘扩散以及碳青霉烯抑制技术来检查CP酶。进行了多重实时PCR技术,以鉴定在肠杆菌科(KPC,NDM,和OXA-48)。本研究中的大多数参与者(58.3%)居住在城市地区。共有227例(59.1%)患者住院。此外,26.04%的患者被确定患有肠杆菌科细菌感染。大肠杆菌是总体上最普遍的(9.1%)分离株,其次是肺炎克雷伯菌(8.07%),鲍曼不动杆菌(2.6%),铜绿假单胞菌(3.1%),阴沟肠杆菌(1.3%),变形杆菌。(1.3%),和Morganellaspp.(0.5%)。被研究的病人患有尿路感染(48.6%),血流感染(32.2%),伤口感染(11.9%),和呼吸道感染(7.03%),用细菌培养物证实。31.4%的大肠杆菌对碳青霉烯类抗生素耐药,肺炎克雷伯菌占25.8%,50%的铜绿假单胞菌,25%的鲍曼不动杆菌,阴沟肠球菌分离株中占20%。如此高的产生CP和ESBL的肠杆菌科是令人震惊的,表明在研究区域的高传播。建议实施更好的感染预防和控制策略,并在全国范围内进一步筛查这些病原体的携带者。这可能有助于减少高抗性错误的负担。
    Enterobacteriaceae have been classified as severely drug resistant bacteria by the World Health Organization due to their extensive production and dissemination of carbapenemases (CPs) and extended-spectrum β-lactamases (ESBL). The current study was conducted with the aim to determine the prevalence of CP- and ESBL-producing Enterobacteriaceae, as well as their antibiotic susceptibility profiles. For this, a hospital-based study was conducted which included 384 participants with bacterial infections. The collection and processing of specimens was conducted per standard microbiological protocol. The samples were inoculated on agar media plates to obtain the bacterial growths, and if they were positive for any bacterial growth, the antibiotic susceptibility testing was performed using disk diffusion method to check their antibiotic susceptibility patterns. The double disc diffusion as well as carbapenem inhibition techniques were used to examine the CP enzymes. Multiplex real-time PCR technique was performed to identify three distinct genetic types of CPs that have been identified in the Enterobacteriaceae (KPC, NDM, and OXA-48). A majority of participants (58.3%) in the current study were living in urban areas. A total of 227 (59.1%) patients were hospitalized. Furthermore, 26.04% of the patients were determined to be suffering from infections with Enterobacteriaceae. Escherichia coli was the most prevalent (9.1%) isolate overall, followed by Klebsiella pneumoniae (8.07%), Acinetobacter baumannii (2.6%), Pseudomonas aeruginosa (3.1%), Enterobacter cloacae (1.3%), Proteus spp. (1.3%), and Morganella spp. (0.5%). The studied patients were suffering from urinary tract infections (48.6%), blood stream infections (32.2%), wounds infection (11.9%), and respiratory infections (7.03%), confirmed with bacterial cultures. The resistance against carbapenems was seen in 31.4% of E. coli isolates, 25.8% in K. pneumoniae, 50% in P. aeruginosa, 25% in A. baumannii, and 20% in E. cloacae isolates. Such high rates of CP- and ESBL-producing Enterobacteriaceae are alarming, suggesting high spread in the study area. It is advised to implement better infection prevention and control strategies and conduct further nationwide screening of the carriers of these pathogens. This might help in reducing the burden of highly resistant bugs.
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  • 文章类型: Journal Article
    背景:耐碳青霉烯类肺炎克雷伯菌(cr-Kp)引起与高死亡率相关的严重感染。头孢他啶/阿维巴坦(CZA)的临床疗效,美罗培南/伐巴坦(M/V),抗cr-Kp的亚胺培南/雷巴坦(I/R)受到耐药菌株的出现的挑战,使主要抗性机制的调查和监测至关重要。在这项研究中,我们报道了从重症患者中分离出的肺炎克雷伯菌菌株的基因组特征,其特征在于多药耐药(MDR)谱,包括对CZA的抗性,M/V,和I/R
    方法:通过自动化系统和E测试进行抗菌药物敏感性试验(AST),并按照EUCAST指南解释结果。使用基因组DNA提取试剂盒提取基因组DNA,并使用IlluminaNovaSeq6000平台对其进行测序。最后的组装是手工策划和仔细验证的抗菌素抗性基因的检测,孔修饰,和毒力因子。
    结果:肺炎克雷伯菌属序列型ST512,有23个耐药基因,赋予所有种类的抗生素抗性,包括blaKPC-31和blaOXA-181,导致碳青霉烯类耐药。还观察到OmpK35的截短和突变OmpK36GD。
    结论:基因组特征证明了新的cr-Kp共携带A类和D类碳青霉烯酶的高抗性特征。KPC-31的存在,以及OXA-181和孔蛋白修饰的检测,进一步限制治疗选择,包括β-内酰胺/β-内酰胺酶抑制剂抗生素在cr-Kp引起的重症肺炎患者中的新型组合。
    BACKGROUND: Carbapenem resistant Klebsiella pneumoniae (cr-Kp) causes serious infections associated with a high mortality rate. The clinical efficacy of ceftazidime/avibactam (CZA), meropenem/vaborbactam (M/V), and imipenem/relebactam (I/R) against cr-Kp is challenged by the emergence of resistant strains, making the investigation and monitoring of the main resistance mechanisms crucial. In this study, we reported the genome characterization of a Klebsiella pneumoniae strain isolated from a critically ill patient and characterized by a multidrug resistant (MDR) profile, including resistance to CZA, M/V, and I/R.
    METHODS: An antimicrobial susceptibility test (AST) was performed by an automated system and E-test and results were interpreted following the EUCAST guidelines. Genomic DNA was extracted using a genomic DNA extraction kit and it was sequenced using the Illumina Nova Seq 6000 platform. Final assembly was manually curated and carefully verified for detection of antimicrobial resistance genes, porins modifications, and virulence factors.
    RESULTS: The K. pneumoniae isolate belonged to sequence type ST512 and harbored 23 resistance genes, conferring resistance to all antibiotic classes, including blaKPC-31 and blaOXA-181, leading to carbapenems resistance. The truncation of OmpK35 and mutation OmpK36GD were also observed.
    CONCLUSIONS: The genomic characterization demonstrated the high resistant profile of new cr-Kp coharboring class A and D carbapenemases. The presence of KPC-31, as well as the detection of OXA-181 and porin modifications, further limit the therapeutic options, including the novel combinations of β-lactam/β-lactamase inhibitor antibiotics in patients with severe pneumonia caused by cr-Kp.
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  • 文章类型: Journal Article
    未经批准:耐碳青霉烯的肠杆菌科(CRE)在过去十年中已成为重大的公共卫生问题。我们的目的是探讨CRE感染患者死亡的危险因素,并关注目前关于抗微生物治疗CRE感染的证据。特别是从死亡率的角度来看。
    未经评估:通过搜索EMBASE的数据库进行了系统的文献综述,PubMed,和Cochrane图书馆,以确定评估2012年至2022年发表的CRE感染的死亡率相关危险因素和抗菌方案的研究。
    未经批准:总共,纳入33和28项研究,分析危险因素和抗生素治疗,分别。最常报告与CRE死亡率显著相关的危险因素是抗生素使用(92.9%;26/28研究)。合并症(88.7%;23/26研究),和医院相关因素(82.8%;24/29项研究)。在10项不含头孢他啶/阿维巴坦(CAZ-AVI)治疗的研究中,7例联合治疗的死亡率显著低于单药治疗.然而,6项研究中的5项确定CAZ-AVI单一疗法和CAZ-AVI组合疗法之间没有实质性差异。6项研究报告CAZ-AVI方案的死亡率明显低于其他方案。
    未经评估:几个危险因素,特别是抗生素的使用和患者的合并症,是CRE死亡率的强危险因素。CRE感染的最佳方案仍存在争议。当碳青霉烯类抗生素时,应考虑联合治疗,粘菌素,替加环素,或给予氨基糖苷类。CAZ-AVI似乎是CRE感染的有希望的抗生素。最重要的是,应根据疾病的来源和严重程度或其他高度相关的危险因素进行个体化治疗。
    UNASSIGNED: Carbapenem-resistant Enterobacteriaceae (CRE) has become a significant public health problem in the last decade. We aimed to explore the risk factors of mortality in patients with CRE infections and to focus on the current evidence on antimicrobial regimens for CRE infections, particularly from the perspective of mortality.
    UNASSIGNED: A systematic literature review was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library to identify studies that evaluated mortality-related risk factors and antimicrobial regimens for CRE infections published from 2012 to 2022.
    UNASSIGNED: In total, 33 and 28 studies were included to analyze risk factors and antibiotic treatment, respectively. The risk factors most frequently reported as significantly associated with CRE mortality were antibiotic use (92.9%; 26/28 studies), comorbidities (88.7%; 23/26 studies), and hospital-related factors (82.8%; 24/29 studies). In 10 studies that did not contain ceftazidime/avibactam (CAZ-AVI) therapy, seven demonstrated significantly lower mortality in combination therapy than in monotherapy. However, 5 of 6 studies identified no substantial difference between CAZ-AVI monotherapy and CAZ-AVI combination therapy. Six studies reported substantially lower mortality in CAZ-AVI regimens than in other regimens.
    UNASSIGNED: Several risk factors, particularly antibiotic use and patients\' comorbidities, are strong risk factors for CRE mortality. The optimal regimen for CRE infections remains controversial. Combination therapy should be considered when carbapenems, colistin, tigecycline, or aminoglycosides are administered. CAZ-AVI appears to be a promising antibiotic for CRE infections. Most importantly, treatment should be individualized according to the source and severity of the disease or other highly related risk factors.
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    文章类型: English Abstract
    BACKGROUND: The problem of carbapenemase-producing Enterobacteriaceae (CPE) was exacerbated by the COVID-19 pandemic in countries with a previous high incidence, such as Argentina. This study describes the development and results of a CPE prevention program, mainly carbapenemase-producing Klebsiellas (KPC), in three critical units of two public hospitals during 6 months of the pandemic.
    METHODS: The objective was to reduce the incidence of KPC in clinical and colonization samples. This quasi-experimental study was based on a cycle of improvement and implementation of three measures: hand hygiene, environmental hygiene, and periodic surveillance with rectal swabs.
    RESULTS: Regarding the measures, all the units optimized active surveillance, and two of these also improved hand and environmental hygiene. Comparing the pre- and post-intervention periods in the three units, no significant change was observed in the rate of KPC positive clinical samples. KPC colonization was significantly reduced in two units (unit 2: 51.6-18.5 p 0.0004, unit 3: 62.5-5.2 p < 0.0000001). All units showed a downtrend in both rates towards the end of the study.
    CONCLUSIONS: Containing or reducing the advance of the KPC in our region is possible even in difficult scenarios such as the pandemic. More studies are needed in low- and middle-income countries to demonstrate the impact of KPC prevention programs in these situations.
    Introducción: La problemática de las enterobacterias productoras de carbapenemasas (EPC) se exacerbó con la pandemia por COVID-19 en países con una incidencia previa elevada, como la Argentina. Este estudio describe el desarrollo y resultados de un programa de prevención de EPC, fundamentalmente Klebsiellas productoras de carbapenemasas (KPC), en tres unidades críticas de dos hospitales públicos durante 6 meses de la pandemia. Métodos: El objetivo fue reducir la incidencia de KPC en muestras clínicas y de colonización. Este estudio, quasi experimental, se basó en un ciclo de mejora e implementación de tres medidas: higiene de manos, higiene ambiental y vigilancia periódica con hisopados rectales. Resultados: Respecto a las medidas, todas las unidades mejoraron la vigilancia activa y dos de estas tuvieron además mejoría en la higiene de manos e higiene ambiental. Comparando los períodos pre y post intervención en las tres unidades no se observaron cambios significativos en la tasa de muestras clínicas KPC positivas. Se logró disminuir en forma significativa la colonización por KPC en dos unidades (unidad 2: 51.6-18.5 p 0.0004, unidad 3: 62.5-5.2 p < 0.0000001). Todas las unidades mostraron hacia el final del estudio una tendencia al descenso en ambas tasas. Conclusión: Contener o reducir el avance de KPC en nuestra región es posible incluso en escenarios difíciles como el de la pandemia. Se necesitan más estudios en países de ingresos bajos y medianos, para demostrar el impacto de los programas de prevención de KPC en estas situaciones.
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  • 文章类型: Case Reports
    未经证实:假体周围关节感染(PJI)是全膝关节镜检查后的主要并发症。肠杆菌是PJI的罕见病因。
    UNASSIGNED:我们介绍了一名65岁的白种人,他在接受右膝关节内肿块切除和假体内重建两个月后,出现了急性右膝PJI并伴有耐碳青霉烯类肠杆菌(CRE)。假体周围感染(PJI)采用1期静态垫片和IV美罗培南翻修治疗。
    未经证实:CRE是导致PJI的罕见原因,但是当它真的发生时,它通常感染免疫抑制或有特定危险因素的患者。对于具有免疫能力的CREPJI患者,我们建议对其他系统性疾病进行进一步检查.
    UNASSIGNED:该病例证明了早期诊断和治疗CRE关节感染的重要性,以及对包括积极手术干预和定制抗菌治疗在内的多学科方法的需求。
    UNASSIGNED: Periprosthetic joint infection (PJI) is a major complication after total knee arthroscopy. Enterobacter is a rare cause of PJI.
    UNASSIGNED: We present a 65 year old Caucasian man who presented with acute right knee PJI with Carbapenem-resistant Enterobacteriaceae (CRE) two months after undergoing right knee intra-articular mass removal with endoprosthetic reconstruction. The periprosthetic joint infection (PJI) was treated with revision with 1-stage static spacer and IV meropenem.
    UNASSIGNED: CRE is an uncommon cause of PJI, but when it does occur, it commonly infects patients who are immunosuppressed or have specific risk factors. For an immunocompetent patient with CRE PJI, we suggest further workup for other systemic disease.
    UNASSIGNED: This case demonstrates the importance of early diagnosis and treatment of CRE joint infections and the need for a multidisciplinary approach that includes aggressive surgical intervention and tailored antimicrobial therapy.
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  • 文章类型: Journal Article
    耐碳青霉烯类肠杆菌科(CRE)在全球范围内迅速传播,并因其对“最后一线”抗生素的耐药性而成为对医疗保健系统的全球威胁。本研究旨在调查CRE的患病率和耐药机制以及与住院死亡率相关的危险因素。
    本研究共纳入2014-2015年某三级教学医院分离的168株CRE菌株。碳青霉烯酶基因的存在和亚胺培南的最小抑制浓度,对美罗培南和粘菌素进行了研究。所有耐碳青霉烯类肺炎克雷伯菌(K.肺炎)菌株通过PFGE表征。统计确定与住院死亡率相关的CRE感染患者的危险因素。
    分离的主要CRE物种是肺炎克雷伯菌。检测到的碳青霉烯酶为blaOXA-48,blaOXA-232,blaVIM和blaNDM,其中blaOXA-48是在168个CRE菌株中检测到的主要碳青霉烯酶。总共40个CRE菌株具有两种不同的碳青霉烯酶基因。在140个CRKp菌株中总共鉴定出7个簇和48个脉冲型。确定了导致2014年至2015年传播的主要脉型。单变量统计分析发现,从CRE隔离到开始适当治疗3天以上的时间与住院死亡率有统计学关联。
    Carbapenem resistant Enterobacteriaceae (CRE) has rapidly disseminated worldwide and has become a global threat to the healthcare system due to its resistance towards \"last line\" antibiotics. This study aimed to investigate the prevalence of CRE and the resistance mechanism as well as the risk factors associated with in-hospital mortality.
    A total of 168 CRE strains isolated from a tertiary teaching hospital from 2014-2015 were included in this study. The presence of carbapenemase genes and minimum inhibitory concentration of imipenem, meropenem and colistin were investigated. All carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) strains were characterised by PFGE. The risk factors of patients infected by CRE associated with in-hospital mortality were determined statistically.
    The predominant CRE species isolated was K. pneumoniae. The carbapenemases detected were blaOXA-48, blaOXA-232, blaVIM and blaNDM of which blaOXA-48 was the predominant carbapenemase detected among 168 CRE strains. A total of 40 CRE strains harboured two different carbapenemase genes. A total of seven clusters and 48 pulsotypes were identified among 140 CRKp strains. A predominant pulsotype responsible for the transmission from 2014 to 2015 was identified. Univariate statistical analysis identified that the period between CRE isolation and start of appropriate therapy of more than 3 days was statistically associated with in-hospital mortality.
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