Health care settings *
Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse in Routledge Handbook of Water and Health, 2015
Associated outbreaks in health care facilities are well described in the literature whereas sanitation system associated outbreaks are described only in a few publications. In the last few years, there have been well documented nosocomial outbreaks in which the sanitation system and its controls were identified as infection reservoirs, especially for Pseudomonas aeruginosa and antibiotic-resistant carbapenemase-producing Enterobacteriaceae.11,12, 13 Therefore it is of utmost importance to also take into account the sanitation system when there is an increase in those pathogens. Even today, official guidelines for prevention and control of health care associated infections to control carbapenemase-producing Enterobacteriaceae do not take into account water and sanitation systems as a reservoir. All that is proposed is the screening and training of health care workers in hand hygiene and isolating or grouping infected or colonized patients.
Chapter 8 Antibiotics: help or hindrance?
Paul Elliott, Julie Storr, Annette Jeanes, Barry Professor Cookson, Benedetta Professor Allegranzi, Marilyn ADJ Professor Cruickshank in Infection Prevention and Control, 2017
Carbapenem antibiotics, such as imipenem and meropenem, have a broad spectrum of activity and are used for the treatment of severe hospital-associated infections and polymicrobial infections.16 As such they are often used as last-line treatments for resistant infections. Worryingly, carbapenem resistance has begun to develop, resulting in bacteria that are resistant to all but a handful of antibiotics. A growing number of bacteria from the Enterobacteriaceae species, such as E. coli and Klebsiella, have been noted to produce carbapenemase enzymes.17 These enzymes destroy carbapenem antibiotics, and therefore bacteria producing them can cause multidrug-resistant infections.18 Resulting infections present a therapeutic challenge, as there are limited treatment options, such as colistin and tigecycline.19 This is has been a growing problem in recent years. The United States, India and parts of Europe are all reported to have high prevalence of healthcare-associated carbapenemase-producing Enterobacteriaceae.20
The Microbiology Laboratory
Keith Struthers in Clinical Microbiology, 2017
The carbapenemase-producing Enterobacteriaceae (CPE) pose a critical challenge in clinical diagnosis, treatment and infection control. There are also two important laboratory diagnostic issues: Conventional culture and antibiotic susceptibility testing takes several days for the final result.Conventional susceptibility testing determines the phenotypic susceptibility profile of the organism. Isolates of Klebsiella can appear to be producing a carbapenemase, but on further examination are producing an ESBL and also have reduced susceptibility to carbapenems due to porin restriction, which gives the false carbapenemase-producing phenotype.
Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections
Published in Expert Opinion on Pharmacotherapy, 2020
S.G. Kuiper, E. Leegwater, E.B. Wilms, C. van Nieuwkoop
Infections of the urinary tract are one of the most common bacterial infections. Health care-associated costs for this group of patients are substantial and increases after hospitalization [1]. The incidence of complicated urinary tract infection (UTI), including pyelonephritis and urosepsis, increases with age and women are more affected than men [2]. Most common causative bacteria are Gram-negative bacteria like Enterobacterales. Currently, multidrug resistance (MDR) is emerging and carbapenemase producing Gram-negative bacteria are of particular concern as this may result in untreatable and incurable complicated UTI (cUTI) and ultimately death. In order to prevent untreatable UTI, carbapenems are generally used as reserve antibiotics [3]. The World Health Organization deemed research into treatment of carbapenemase producing Enterobacterales, including the development of new antibiotics, as critical [4]. A treatment strategy to battle resistance in carbapenemase producing bacteria that’s currently being followed is the addition of a β-lactamase inhibitor to carbapenem antibiotics. One example is imipenem/cilastatin/relebactam (IMI/REL). This review discusses the use of imipenem/cilastatin/relebactam in patients with UTIs.
Emergence of VIM-2-producing Citrobacter freundii in Japan
Published in Infectious Diseases, 2018
Sayaka Ando, Ryuichi Nakano, Tomokazu Kuchibiro, Katsutoshi Yamasaki, Yuki Suzuki, Akiyo Nakano, Tomoki Mizuno, Kei Kasahara, Hisakazu Yano
Carbapenemase-producing Enterobacteriaceae show multi-antibiotic resistance; thus, infections with these bacteria are difficult to treat, representing a growing problem worldwide. Carbapenemase is often encoded by a plasmid that spreads via conjugal transfer. In the present journal, a recent report from Zhejiang Province, China payed attention to the increasing emergence of carbapenem resistance in gram-negative bacteria [1]. In 70.4% (59/71) isolates of carbapenem-resistant Enterobacteriaceae, two carbapenemase-encoding genes were detected, namely blaKPC-2 and blaIMP-4/blaIMP-8. Among class B metallo-β-lactamases, blaVIM were detected in Pseudomonas aeruginosa but occurred in none of not 71 isolates of carbapenem-resistant strains of Enterobacteriaceae. Aiming to add information to the present increasing emergence of carbapenemase-producing gram-negatives, we here report our detection of VIM-2-producing Citrobacter freundii in Japan.
Carbapenemase-producing Enterobacterales infections in COVID-19 patients
Published in Infectious Diseases, 2022
Vicente Pintado, Patricia Ruiz-Garbajosa, Rosa Escudero-Sanchez, Francesca Gioia, Sabina Herrera, Pilar Vizcarra, Jesús Fortún, Javier Cobo, Pilar Martín-Dávila, María Isabel Morosini, Rafael Cantón, Santiago Moreno
K. pneumoniae (59, 80.8%), Serratia marcescens (8, 11%), and Enterobacter cloacae (3, 4.1%) were the most common bacteria in both groups (Table 2). The most common type of carbapenemase was KPC (41, 56.2%), followed by OXA-48 (19, 26.0%) and VIM metallo-beta-lactamase (13, 17.8%). There were no significant differences either in the distribution of bacterial species or in the type of carbapenemase between cases and controls. Most isolates were resistant to piperacillin-tazobactam (100%), cefepime (93.2%), ceftazidime (93.2%), ertapenem (97.3%) and imipenem (75.3%), while the resistance rate to ceftazidime-avibactam (CZA) (0%), tigecycline (11.9%) and amikacin (18.3%), was significantly lower (Table 3). Around a half of VIM-producing isolates were susceptible to aztreonam (50%) and ciprofloxacin (53.8%). No significant differences were found in resistance rates between cases and controls. CPE infection was polymicrobial in 21.9% (16/73) of the cases, with a similar proportion of cases and controls (Table 2).
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- Antibiotic
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- Beta-Lactam