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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Carbapenem-resistant Enterobacteriaceae (CRE) have acquired resistance by one of several mechanisms such as developing carbapenemases that cleave the beta-lactam ring, or developing efflux pumps to actively transport the drug out of cells.
AmpC, Extended-Spectrum β-Lactamase and Carbapenemase Producers
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Because of the scarcity of information, fosfomycin is not a first option against serious CRE infections when other active drugs are available, but it may be needed in some patients with scarce options. In such cases, a fosfomycin dose of 16–24 g per day as part of combination therapy is recommended.
Colonization, Infection, and Resistance in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Since there is a direct relationship between colonization pressure and healthcare CRE transmission, infection prevention guidelines recommend contact precautions: For all patients either colonized or infected with CRE, use dedicated staff, rooms, and equipment [57]. Environmental cleaning and disinfection have been shown to reduce infections caused by VRE and C. difficile. The evidence for CRE is less convincing due to shorter environmental survival time [58]. However, during CRE outbreaks, cleaning of the environment, especially high-touch surfaces, may assist in reducing transmission [59].
Incidence and risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care units: a matched case–control study
Published in Expert Review of Anti-infective Therapy, 2021
Fahad A S Aleidan, Hind Alkhelaifi, Aljouharah Alsenaid, Haya Alromaizan, Fajer Alsalham, Alhanouf Almutairi, Khalid Alsulaiman, Abdel Galil Abdel Gadir
In the current study, we evaluated the incidence and risk factors associated with the infection of CRE among patients admitted to different ICUs at KAMC, a tertiary hospital in Riyadh. The CRE infection rate among patients infected with Enterobacteriaceae was 7.6% (142/1,864) and the incidence rate of CRE infection was 5.6 per 1,000 person-days. The reported incidence of CRE infection in the United States is 2.93 per 100,000 people [23]. In another study, Brazilian authors reported a CRE infection rate of 18% [24]. Asian countries have reported lower CRE incidence; for example, the detection rate of CRE in Japan is 0.22% [25], and in Korea, the overall CRE infection rate was 2.9% in patients admitted to ICU [26]. A similar low CRE infection incidence of 4 per 10,000 discharges was reported from China [27].
Pharmacotherapeutic advances for recurrent urinary tract infections in women
Published in Expert Opinion on Pharmacotherapy, 2020
Mohamad Moussa, Mohamed Abou Chakra, Athanasios Dellis, Yasmin Moussa, Athanasios Papatsoris
To date, the treatment options for CRE infections remain very limited. Polymyxins (colistin or polymyxin B) and tigecycline have been traditionally considered as drugs of choice for infections caused by CRE. Carbapenems still play a role in the treatment of CRE infections, particularly when used in the treatment of CRE with lower MICs, either in higher doses in combination with other active anti-CRE agents, or through double-carbapenem therapy [17]. Women with rUTIs can be successfully treated with electrofulguration, and more than 80% experience long-term clinical cure [18]. Recurrent or relapsing UTIs often result from urinary stasis. For complex cases, UTIs are often associated with conditions, such as anatomical or functional abnormalities of the genitourinary tract, or the presence of an underlying disease. Therapeutic surgical options may be considered to remove the source of infection, and secondly, to improve or restore any predisposing conditions [19].
Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI)
Published in The Journal of Spinal Cord Medicine, 2019
Alexander B. Chew, Katie J. Suda, Ursula C. Patel, Margaret A. Fitzpatrick, Swetha Ramanathan, Stephen P. Burns, Charlesnika T. Evans
Multi-drug resistant organisms were defined as intermediate or resistant to ≥3 of the following antimicrobial groups: 1st-4th generation cephalosporins, aminoglycosides, fluoroquinolones, carbapenems, cephamycins, folate pathway inhibitors, glycylcyclines, antipseudomonal penicillins, β–lactam/β-lactamase inhibitors, penicillins, phenicols, monobactams, polymyxins, and tetracyclines.29 Carbapenem-resistant Enterobacteriaceae (CRE) were defined as gram-negative bacteria nonsusceptible (intermediate or resistant) to carbapenems. Intrinsic resistance was not considered in the definition of CRE. A modified Charlson comorbidity index30 was calculated for all patients using clinical data collected from the year prior to the study period (10/1/2011-9/30/2012).