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Outcomes and Genetic Relatedness of Carbapenem-Resistant Enterobacteriaceae at Detroit Medical Center

Published online by Cambridge University Press:  02 January 2015

Dror Marchaim
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Teena Chopra
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Federico Perez
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University, Cleveland, Ohio
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Paul R. Lephart
Affiliation:
Department of University Laboratories, Wayne State University, Detroit, Michigan
Suchitha Bheemreddy
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Christopher Blunden
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Andrea M. Hujer
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Susan Rudin
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Maryann Shango
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Michelle Campbell
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jastin Varkey
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jessica Slim
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Farah Ahmad
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Diixa Patel
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Ting-Yi Chen
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jason M. Pogue
Affiliation:
Department of Pharmacy Services, Detroit Medical Center, Wayne State University, Detroit, Michigan
Hossein Salimnia
Affiliation:
Department of University Laboratories, Wayne State University, Detroit, Michigan
Sorabh Dhar
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University, Cleveland, Ohio VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, Ohio and Department of Pharmacology and Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Corresponding
E-mail address:

Abstract

Background.

Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging in hospitals in the United States and are posing a significant threat. To better understand the transmission dynamics and the acquisition of resistant strains, a thorough analysis of epidemiologic and molecular characteristics was performed.

Methods.

CRE isolated at Detroit Medical Center were analyzed from September 2008 to September 2009. blaKPC genes were investigated by polymerase chain reaction (PCR), and repetitive extragenic palindromic PCR (rep-PCR) was used to determine genetic similarity among strains. Epidemiologic and outcomes analyses were performed.

Results.

Ninety-two unique patient CRE isolates were recovered. Sixty-eight strains (74%) were Klebsiella pneumoniae, 7 were Klebsiella oxytoca, 15 were Enterobacter species, and 2 were Escherichia coli. Fifteen isolates (16%) were resistant to Colistin, 14 (16%) were resistant to tigecycline, and 2 were resistant to all antimicrobials tested. The mean ± standard deviation age of patients was 63 ± 2 years. Sixty patients (68%) were admitted to the hospital from long-term care facilities. Only 70% of patients received effective antimicrobial therapy when infection was suspected, with a mean time to appropriate therapy of 120 ± 23 hours following sample culturing. The mean length of hospitalization after sample culturing was 18.6 ± 2.5 days. Of 57 inpatients, 18 (32%) died in the hospital. Independent predictors for mortality were intensive care unit stay (odds ratio [OR], 15.8; P = .003) and co-colonization with CRE and either Acinetobacter baumannii or Pseudomonas aeruginosa (OR, 17.2; P = .006). Among K. pneumoniae CRE, rep-PCR revealed 2 genetically related strains that comprised 70% and 20% of isolates, respectively.

Conclusions.

In this large U.S. cohort of patients with CRE infection, which reflects the modern continuum of medical care, co-colonization with CRE and A. baumannii or P. aeruginosa was associated with increased mortality. Two predominant clones of K. pneumoniae accounted for the majority of cases of CRE infection.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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