Multicenter Clinical and Molecular Epidemiological Analysis of Bacteremia Due to Carbapenem-Resistant Enterobacteriaceae (CRE) in the CRE Epicenter of the United States.

Autor:	Satlin MJ; Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA mjs9012@med.cornell.edu., Chen L; Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA., Patel G; Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Gomez-Simmonds A; Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA., Weston G; Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA., Kim AC; Division of Infectious Diseases, Northwell Health, Manhasset, New York, USA., Seo SK; Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Rosenthal ME; Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA.; Department of Medicine, St. Peter's University Hospital, New Brunswick, New Jersey, USA., Sperber SJ; Division of Infectious Diseases, Hackensack University Medical Center, Hackensack, New Jersey, USA., Jenkins SG; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA., Hamula CL; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Uhlemann AC; Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA., Levi MH; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA., Fries BC; Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA.; Division of Infectious Diseases, Stony Brook University Medical Center, Stony Brook, New York, USA., Tang YW; Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Juretschko S; Department of Pathology, Northwell Health, Manhasset, New York, USA., Rojtman AD; Department of Pathology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA., Hong T; Department of Pathology, Hackensack University Medical Center, Hackensack, New Jersey, USA., Mathema B; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA., Jacobs MR; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Walsh TJ; Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.; Departments of Pediatrics and Microbiology & Immunology, Weill Cornell Medicine, New York, New York, USA., Bonomo RA; Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.; Department of Medicine, Pharmacology, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., Kreiswirth BN; Public Health Research Institute, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Jazyk:	angličtina
Zdroj:	Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2017 Mar 24; Vol. 61 (4). Date of Electronic Publication: 2017 Mar 24 (Print Publication: 2017).
DOI:	10.1128/AAC.02349-16
Abstrakt:	Although the New York/New Jersey (NY/NJ) area is an epicenter for carbapenem-resistant Enterobacteriaceae (CRE), there are few multicenter studies of CRE from this region. We characterized patients with CRE bacteremia in 2013 at eight NY/NJ medical centers and determined the prevalence of carbapenem resistance among Enterobacteriaceae bloodstream isolates and CRE resistance mechanisms, genetic backgrounds, capsular types ( cps ), and antimicrobial susceptibilities. Of 121 patients with CRE bacteremia, 50% had cancer or had undergone transplantation. The prevalences of carbapenem resistance among Klebsiella pneumoniae , Enterobacter spp., and Escherichia coli bacteremias were 9.7%, 2.2%, and 0.1%, respectively. Ninety percent of CRE were K. pneumoniae and 92% produced K. pneumoniae carbapenemase (KPC-3, 48%; KPC-2, 44%). Two CRE produced NDM-1 and OXA-48 carbapenemases. Sequence type 258 (ST258) predominated among KPC-producing K. pneumoniae (KPC- Kp ). The wzi154 allele, corresponding to cps-2 , was present in 93% of KPC-3- Kp , whereas KPC-2- Kp had greater cps diversity. Ninety-nine percent of CRE were ceftazidime-avibactam (CAZ-AVI)-susceptible, although 42% of KPC-3- Kp had an CAZ-AVI MIC of ≥4/4 μg/ml. There was a median of 47 h from bacteremia onset until active antimicrobial therapy, 38% of patients had septic shock, and 49% died within 30 days. KPC-3- Kp bacteremia (adjusted odds ratio [aOR], 2.58; P = 0.045), cancer (aOR, 3.61, P = 0.01), and bacteremia onset in the intensive care unit (aOR, 3.79; P = 0.03) were independently associated with mortality. Active empirical therapy and combination therapy were not associated with survival. Despite a decade of experience with CRE, patients with CRE bacteremia have protracted delays in appropriate therapies and high mortality rates, highlighting the need for rapid diagnostics and evaluation of new therapeutics. (Copyright © 2017 American Society for Microbiology.)
Databáze:	MEDLINE
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