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Recent Exposure to Antimicrobials and Carbapenem-Resistant Enterobacteriaceae: The Role of Antimicrobial Stewardship

Published online by Cambridge University Press:  02 January 2015

Dror Marchaim ,
Teena Chopra ,
Ashish Bhargava ,
Christopher Bogan ,
Sorabh Dhar ,
Kayoko Hayakawa ,
Jason M. Pogue ,
Suchitha Bheemreddy ,
Christopher Blunden  and
Maryann Shango
...Show all authors
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
Ashish Bhargava
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Christopher Bogan
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Sorabh Dhar
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Kayoko Hayakawa
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
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
Maryann Shango
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jessie Swan
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Paul R. Lephart
Affiliation:
Department of Clinical Microbiology, 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
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 Veterans Integrated Service Network 10 Geriatric Research, Education, and Clinical Centers at Veterans Affairs Medical Center, Cleveland, Ohio Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio 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
*
Division of Infectious Diseases, 5 Hudson, Harper University Hospital, 3990 John R. Street, Detroit, MI 48201 (drormc@hotmail.com)
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Abstract

Background.

Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures. To identify specific predictors of CRE, patients with CRE were compared with 3 control groups: (1) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, (2) patients with non-ESBL-containing Enterobacteriaceae, and (3) uninfected controls.

Design.

Matched multivariable analyses.

Patients and Setting.

Patients possessing CRE that were isolated at Detroit Medical Center from September 1, 2008, to August 31, 2009.

Methods.

Patients were matched (1:1 ratio) to the 3 sets of controls. Matching parameters included (1) bacteria type, (2) hospital/ facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Matched multivariable analyses were conducted between uninfected controls and patients with CRE, ESBL, and non-ESBL Enterobacteriaceae. Models were also designed comparing patients with CRE to patients with ESBL, patients with non-ESBL Enterobacteriaceae, and all 3 non-CRE groups combined.

Results.

Ninety-one unique patients with CRE were identified, and 6 matched models were constructed. Recent (less than 3 months) exposure to antibiotics was the only parameter that was consistently associated with CRE, regardless of the group to which CRE was compared, and was not independently associated with isolation of ESBL or non-ESBL Enterobacteriaceae.

Conclusions.

Exposure to antibiotics within 3 months was an independent predictor that characterized patients with CRE isolation. As a result, antimicrobial stewardship efforts need to become a major focus of preventive Interventions. Regulatory focus regarding appropriate antimicrobial use might decrease the detrimental effects of antibiotic misuse and spread of CRE.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 817 - 830
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a countrywide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7): 848–855.CrossRefGoogle Scholar
2.Endimiani, A, Depasquale, JM, Forero, S, et al. Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64(5): 1102–1110.Google Scholar
3.Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fish-man, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30(12): 1180–1185.CrossRefGoogle ScholarPubMed
4.Munoz-Price, LS, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(4): 341–347.Google Scholar
5.Souli, M, Galani, I, Antoniadou, A, et al. An outbreak of infection due to beta-lactamase Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae in a Greek university hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis 2009;50(3): 364–373.Google Scholar
6.Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58(10): 256–260.Google Scholar
7.Marchaim, D, Chopra, T, Pogue, JM, et al. Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Antimicrob Agents Chemother 2011;55(2):593–599.Google Scholar
8.Marchaim, D, Chopra, T, Perez, F, et al. Outcomes and genetic relatedness of carbapenem-resistant Enterobacteriaceae at Detroit Medical Center. Infect Control Hosp Epidemiol 2011;32(9): 861–871.Google Scholar
9.Leavitt, A, Navon-Venezia, S, Chmelnitsky, I, Schwaber, MJ, Carmeli, Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51(8): 3026–3029.Google Scholar
10.Maltezou, HC, Giakkoupi, P, Maragos, A, et al. Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece). J Infect 2009;58(3): 213–219.Google Scholar
11.Schwaber, MJ, Carmeli, Y. Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA 2008;300(24): 2911–2913.Google Scholar
12.Zarkotou, O, Pournaras, S, Voulgari, E, et al. Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: a matched case-control study. J Clin Microbiol 2010;48(6): 2271–2274.Google Scholar
13.Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31(6): 620–626.Google Scholar
14.Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52(3): 1028–1033.Google Scholar
15.Hussein, K, Sprecher, H, Mashiach, T, Oren, I, Kassis, I, Finkelstein, R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30(7): 666–671.CrossRefGoogle ScholarPubMed
16.Mouloudi, E, Protonotariou, E, Zagorianou, A, et al. Bloodstream infections caused by metauo-β-lactamase/Klebsiella pneumoniae carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol 2010;31(12): 1250–1256.Google Scholar
17.Harris, AD, Carmeli, Y, Samore, MH, Kaye, KS, Perencevich, E. Impact of severity of illness bias and control group misclassification bias in case-control studies of antimicrobial-resistant organisms. Infect Control Hosp Epidemiol 2005;26(4): 342–345.CrossRefGoogle ScholarPubMed
18.Harris, AD, Samore, MH, Lipsitch, M, Kaye, KS, Perencevich, E, Carmeli, Y. Control-group selection importance in studies of antimicrobial resistance: examples applied to Pseudomonas aeruginosa, enterococci, and Escherichia coli. Clin Infect Dis 2002;34(12):1558–1563.Google Scholar
19.Kaye, KS, Harris, AD, Samore, M, Carmeli, Y. The case-case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance. Infect Control Hosp Epidemiol 2005;26(4): 346–351.Google Scholar
20.Schwaber, MJ, Carmeli, Y. Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60(5): 913–920.Google Scholar
21.Harris, AD, Karchmer, TB, Carmeli, Y, Samore, MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001;32(7): 1055–1061.CrossRefGoogle ScholarPubMed
22.Helfand, MS, Bonomo, RA. Extended-spectrum β-lactamases in multidrug-resistant Escherichia coli: changing the therapy for hospital-acquired and community-acquired infections. Clin Infect Dis 2006;43(11): 1415–1416.Google Scholar
23.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care Setting. Am J Infect Control 2008;36(5): 309–332.Google Scholar
24.Dellinger, RP, Levy, MM, Carlet, JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36(1):296–327.Google Scholar
25.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5): 373–383.CrossRefGoogle ScholarPubMed
26.Bion, JF, Edlin, SA, Ramsay, G, McCabe, S, Ledingham, IM. Validation of a prognostic score in critically ill patients undergoing transport. Br Med J (Clin Res Ed) 1985;291(6493):432–434.Google Scholar
27.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Nineteenth Informational Supplement. Approved standard M100-S19. Wayne, PA: CLSI, 2009.Google Scholar
28.Endimiani, A, Hujer, AM, Perez, F, et al. Characterization of blaKPC-containing Klebsiella pneumoniae isolates detected in different institutions in the eastern USA. J Antimicrob Chemother 2009;63(3): 427–437.Google Scholar
29.Perez, F, Pultz, MJ, Endimiani, A, Bonomo, RA, Donskey, CJ. Effect of antibiotic treatment on establishment and elimination of intestinal colonization by KPC-producing Klebsiella pneumoniae in mice. Antimicrob Agents Chemother 2011;55(6): 2585–2589.Google Scholar
30.Marchaim, D, Gottesman, T, Schwartz, O, et al. National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum β-lactamases. Antimicrob Agents Chemother 2010;54(12): 5099–5104.Google Scholar
31.Ben-Ami, R, Rodriguez-Bano, J, Arslan, H, et al. A multinational survey of risk factors for infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in nonhospitalized patients. Clin Infect Dis 2009;49(5): 682–690.Google Scholar
32.Poirel, L, Hombrouck-Alet, C, Freneaux, C, Bernabeu, S, Nordmann, P. Global spread of New Delhi metallo-β-lactamase 1. Lancet Infect Dis 2010;10(12):832.CrossRefGoogle ScholarPubMed
33.Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1): 1–12.CrossRefGoogle ScholarPubMed
34.Tamma, PD, Cosgrove, SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011;25(1):245–260.Google Scholar
35.Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2): 159–177.Google Scholar
36.Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(suppl 2):S27–S72.CrossRefGoogle Scholar
37.Wald, HL, Kramer, AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA 2007;298(23): 2782–2784.Google Scholar
38.Adler, A, Navon-Venezia, S, Moran-Gilad, J, Marcos, E, Schwartz, D, Carmeli, Y. Laboratory and clinical evaluation of screening agar plates for the detection of carbapenem-resistant Enterobacteriaceae from surveillance rectal swabs. J Clin Microbiol 2011;49(6): 2239–2242.Google Scholar
39.Schechner, V, Kotlovsky, T, Tarabeia, J, et al. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol 2011;32(5): 497–503.Google Scholar
40.Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304(18): 2035–2041.Google Scholar