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Review Article
Infection
Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units
Jongyoun Yi, Kye-Hyung Kim
Acute Crit Care. 2021;36(3):175-184.   Published online August 12, 2021
DOI: https://doi.org/10.4266/acc.2021.00409
  • 5,754 View
  • 307 Download
  • 9 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.

Citations

Citations to this article as recorded by  
  • Comparison of mortality rates in patients with carbapenem-resistant Enterobacterales bacteremia according to carbapenemase production: a multicenter propensity-score matched study
    Moon Seong Baek, Jong Ho Kim, Joung Ha Park, Tae Wan Kim, Hae In Jung, Young Suk Kwon
    Scientific Reports.2024;[Epub]     CrossRef
  • Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study
    Małgorzata Timler, Wojciech Timler, Ariadna Bednarz, Łukasz Zakonnik, Remigiusz Kozłowski, Dariusz Timler, Michał Marczak
    International Journal of Environmental Research and Public Health.2023; 20(3): 1960.     CrossRef
  • Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia
    Agumas Shibabaw, Zenawork Sahle, Yeshi Metaferia, Asgdew Atlaw, Behailu Adenew, Alemu Gedefie, Mihret Tilahun, Endris Ebrahim, Yeshimebet Kassa, Habtu Debash, Shu-Hua Wang
    IJID Regions.2023; 7: 77.     CrossRef
  • Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis
    Moon Seong Baek, Seungil Kim, Won-Young Kim, Mi-Na Kweon, Jin Won Huh
    Frontiers in Microbiology.2023;[Epub]     CrossRef
  • ESKAPE and Beyond: The Burden of Coinfections in the COVID-19 Pandemic
    Miguel Ángel Loyola-Cruz, Luis Uriel Gonzalez-Avila, Arturo Martínez-Trejo, Andres Saldaña-Padilla, Cecilia Hernández-Cortez, Juan Manuel Bello-López, Graciela Castro-Escarpulli
    Pathogens.2023; 12(5): 743.     CrossRef
  • Aztreonam: clinical and pharmacological characteristics at the present stage
    D.A. Popov, N.A. Zubareva, A.A. Parshakov
    Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 19.     CrossRef
  • Prevalence and risk factors for colonisation and infection with carbapenem-resistant Enterobacterales in intensive care units: A prospective multicentre study
    Yi-Le Wu, Xiao-Qian Hu, De-Quan Wu, Ruo-Jie Li, Xue-Ping Wang, Jin Zhang, Zhou Liu, Wen-Wen Chu, Xi Zhu, Wen-Hui Zhang, Xue Zhao, Zi-Shu Guan, Yun-Lan Jiang, Jin-Feng Wu, Zhuo Cui, Ju Zhang, Jia Li, Ru-Mei Wang, Shi-Hua Shen, Chao-Yang Cai, Hai-Bin Zhu, Q
    Intensive and Critical Care Nursing.2023; 79: 103491.     CrossRef
  • Epidemiology of Carbapenem-Resistant Enterobacteriaceae Bacteremia in Gyeonggi Province, Republic of Korea, between 2018 and 2021
    Seung Hye Lee, Chan Hee Kim, Hee Young Lee, Kun Hee Park, Su Ha Han
    Antibiotics.2023; 12(8): 1286.     CrossRef
  • Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
    Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
    Microorganisms.2023; 11(12): 2970.     CrossRef
  • Comparison of the certified Copan eSwab system with commercially available cotton swabs for the detection of multidrug-resistant bacteria in rectal swabs
    Norman Lippmann, Sebastian Wendt, Catalina-Suzana Stîngu, Johannes Wiegand, Christoph Lübbert
    American Journal of Infection Control.2022; 50(10): 1145.     CrossRef
  • Clinical Risk Factors and Microbiological and Intestinal Characteristics of Carbapenemase-Producing Enterobacteriaceae Colonization and Subsequent Infection
    Wenli Yuan, Jiali Xu, Lin Guo, Yonghong Chen, Jinyi Gu, Huan Zhang, Chenghang Yang, Qiuping Yang, Shuwen Deng, Longlong Zhang, Qiongfang Deng, Zi Wang, Bin Ling, Deyao Deng, Arryn Craney, Rafael Vignoli
    Microbiology Spectrum.2022;[Epub]     CrossRef
Original Articles
Infection
Outbreak of Imipenemase-1-Producing Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit
Jin Young Lee, Ji Young Park, Je Hun Kim, Young Hee Lee, Hee Young Yang, Jung Sik Yoo
Korean J Crit Care Med. 2017;32(1):29-38.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00731
  • 10,323 View
  • 213 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported.
Methods
Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame.
Results
During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions.
Conclusions
This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.

Citations

Citations to this article as recorded by  
  • Alkyl deoxyglycoside-polymyxin combinations against critical priority carbapenem-resistant gram-negative bacteria
    Ana M. de Matos, Patrícia Calado, Mónica Miranda, Rita Almeida, Amélia P. Rauter, M. Conceição Oliveira, Vera Manageiro, Manuela Caniça
    Scientific Reports.2024;[Epub]     CrossRef
  • Genotypic Distribution and Antimicrobial Susceptibilities of Carbapenemase-Producing Enterobacteriaceae Isolated From Rectal and Clinical Samples in Korean University Hospitals Between 2016 and 2019
    Seri Jeong, Nuri Lee, Min-Jeong Park, Kibum Jeon, Han-Sung Kim, Hyun Soo Kim, Jae-Seok Kim, Wonkeun Song
    Annals of Laboratory Medicine.2022; 42(1): 36.     CrossRef
  • Characterization of Infections with Vancomycin-Intermediate Staphylococcus aureus (VISA) and Staphylococcus aureus with Reduced Vancomycin Susceptibility in South Korea
    Jung Wan Park, Hyungmin Lee, Jung Wook Kim, Bongyoung Kim
    Scientific Reports.2019;[Epub]     CrossRef
Clinical Characteristics in Patients with Carbapenem-Resistant Acinetobacter baumannii Isolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee
Korean J Crit Care Med. 2013;28(3):173-179.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.173
  • 2,807 View
  • 89 Download
AbstractAbstract PDF
BACKGROUND
This study was conducted to evaluate the clinical characteristics and outcomes of mechanically ventilated patients with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from tracheal secretions in a medical intensive care unit (ICU) of a university hospital.
METHODS
We conducted a retrospective study from January 2009 to June 2012.
RESULTS
Among the patients who had isolates cultured from tracheal secretions, 130 patients (34.8%) had CRAB isolates. Their mean age was 65 +/- 14 yr and 74.6% were male. The ICU and hospital mortality was 51.5% and 60.0%, respectively. According to physician's clinical decision, antibiotics were changed in order to cover CRAB in 75 (57.7%) patients. The total duration of antibiotics use was 12.2 +/- 8.1 days. Of patients with antibiotics change to cover CRAB, 70 patients (93.3%) had Clinical Pulmonary Infection Score of 6 and over. However, there was no significant difference in hospital mortality between patients with antibiotics change against CRAB and those without change. In multivariable analysis, only Acute Physiology and Chronic Health Evaluation II score was related to hospital mortality of patients with CRAB.
CONCLUSIONS
In this study, changing antibiotics to cover CRAB by physician's clinical decision only did not influence hospital mortality; further studies would be necessary to investigate how to use antibiotics against CRAB isolates cultured from tracheal secretions.

ACC : Acute and Critical Care