ObjectiveTo detect the in vitro susceptibility of common clinical multidrug-resistant bacteria to tigecycline by disk diffusion (KB), minimum inhibitory concentrations (MIC) test strip (MTS) and Vitek 2 Compact methods, in order to evaluate the accuracy of the three different susceptibility testing methods. MethodsA total of 140 multidrug-resistant isolates (excluding Pseudomonas aeruginosa) were collected retrospectively from West China Hospital between January 2014 and March 2015. The inhibitory zone diameters and MIC of tigecycline were determined by KB, Vitek 2 Compact system and MTS respectively. The results of Vitek 2 Compact system and KB method were compared with that of MTS. ResultsAmong the 140 multidrug-resistant isolates, 119 were Acinetobacter baumannii, and 21 were Enterobacteriaceae. According to the US Food and Drug Administration standards, the sensitivity rates of 119 Acinetobacter baumannii isolates to tigecycline were 88.2%, 85.7%, and 90.8% respectively for KB method, Vitek 2 Compact system and MTS, and those of 21 Enterobacteriaceae were 76.2%, 81.0%, and 81.0%, respectively. ConclusionsTigecycline displays effective in vitro antibacterial activity to clinical common multidrug-resistant bacteria (excluding Pseudomonas aeruginosa), but different susceptibility testing methods have shown different susceptibility rates. For Acinetobacter baumannii, KB method is superior to Vitek 2 Compact system, and for Enterobacteriaceae, Vitek 2 Compact system is superior to KB method.
Objective To explore clinical characteristics and risk factors for mortality of community-acquired pneumonia due to Enterobacteriaceae (EnCAP) . Methods This was a single-center, retrospective study. Baseline demographic, clinic, radiologic characteristcs, treatment and outcomes were compared between patients hospilized with EnCAP and community-acquired pneumonia due to Streptoccocus pneumoniae (SpCAP) during January 1, 2010 to December 31, 2015. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with 30-day mortality for EnCAP. Results In comparison with SpCAP, cerebrovascular disease, chronic hepatopathy, chronic renal disease, aspiration risk, confusion, pleural effusion and higher PSI risk class/CURB-65 score, lower leukocyte, hemoglobin, albumin, longer length of stay in hospital were associated with EnCAP. Multivariate logistic regression analysis demonstrated sepsis shock (OR 1.700, P=0.018, 95%CI 0.781 to 38.326), hemoglobin (OR 0.087, P=0.011, 95%CI 0.857 to 0.981) and appropriate empirical antimicrobial therapy (OR 0.108, P=0.002, 95%CI 0.011 to 0.151) were risk factor for 30-day mortality of EnCAP. Conclusions The clinical characteristics of EnCAP are different with SpCAP. Clinic physicians should pay much attention to the risk factors for 30-day mortality of EnCAP.
ObjectiveTo analyze the distribution and drug resistance of Enterobacteriaceae in West China Hospital of Sichuan University, to provide long-term monitoring data references for clinical practice.MethodsThe clinical information of non-repetitive Enterobacteriaceae isolates from 2006 to 2015 was collected and analyzed. All the isolates were identified by VITEK-2 Compact Automatic Microbial Identification Analyzer (Bio Merieux, France). The statistic informations were analyzed by WHONET 5.6 and iLabDataforMDR 1.03.ResultsA total of 38 487 strains of Enterobacteriaceae were isolated from 2006 to 2015, mainly including 14 862 stains of Escherichia (38.6%), 12 894 stains of Klebsiella (33.5%), 6 277 stains of Enterobacter (16.3%), 1 758 stains of Proteus (4.6%), 1 257 stains of Serratia (3.3%), 933 stains of Citrobacter (2.4%), and 506 stains of Morganella (1.3%). The top three sample types were sputum (46.9%), urine (18.7%), and secretions (11.5%). The drug resistance rate of Enterobacteriaceae showed a downward trend to most antibacterials. The average resistance rate of Enterobacteriaceae to ampicillin, ampicillin/sulbactam, and cefazolin was 85.3%, 52.6%, and 72.9%, respectively. The resistance rates to ceftriaxone, cefepime, gentamicin, and tobramycin were significantly reduced. The resistance rates to other antibiotics showed decreasing or slow increasing trends. The isolation rate of extended-spectrum β-lactamases (ESBL)-producing strains in Escherichia did not change, but the rate in Klebsiella decreased significantly. The isolation rate of multidrug-resistant organisms (MDRO) showed a slow decrease.ConclusionsThe overall antimicrobial resistance and the isolation rates of MDRO and ESBL-producing organisms showed a downward trend in investigating period. However, the carbapenem-resistant Enterobacteriaceae was rising continuously. Long-term monitoring of drug resistance is of notable value to antibiotic management policies.
There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
Carbapenemase producing Enterobacteriaceae (CPE) has emerged as a significant global public health challenge and placing infected patients at risk of potentially untreatable infections. When resistance to carbapenems occurs, there are often few alternative treatments available. Numerous international guidelines have performed systematic and evidence review to identify new strategies to prevent the entry and spread of CPE in healthcare settings. Several key strategies have been shown to be highly effective. Firstly a new strategy that is proven to be effective is the early identification of the CPE carrier patients through active surveillance cultures. While waiting for the screening results, suspected CPE carriers will be put on preemptive isolation in single room and healthcare worker will at the same time practice contact precautions. The active surveillance culture and prompt preemptive isolation will limit the entry and spread of CPE from getting into hospital. Secondly, it is of utmost importance to incorporate enforcement of the basic infection prevention and control best practices in the hospital including, full compliance to hand hygiene, appropriate use of personal protective equipment, execute antibiotic stewardship program to control abuse of antibiotics, effective environmental cleaning and decontamination, staff education and feedback, as well as surveillance of healthcare-associated infections. Such a holistic approach has been shown to be effective in inhibiting CPE from gaining foothold in the hospital.
ObjectiveTo analyze the cost and performance of five methods for detection of carbapenemase-producing Enterobacteriaceae (CPE), including PCR (method A), Carba NP test (method B), ultraviolet spectrophotometry (method C), modified carbapenem inactivation method (mCIM, method D), and loop-mediated isothermal amplification (LAMP, method E).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were searched using the computer regarding literature on detection of CPE with the same or similar designs, same objectives, and independent results. The search was limited between May 2009 and May 2019. Data on the cost and detection performance of all five methods were extracted, and the four special indexes for laboratory tests, such as sensitivity, specificity, simplicity, and rapidity in the utility were quantified as specific values; subsequently, the cost-effective analysis (CEA), cost-utility analysis (CUA), and multi-attribute utility theory (MAUT) in the detection economic analysis were used to conduct health economics evaluation of five detection methods for CPE.ResultsThe cost of methods A, B, C, D and E were 210.00 yuan, 22.00 yuan, 10.50 yuan, 6.00 yuan, and 60.00 yuan, respectively. The C/E of CEA for the above five methods were 210.00, 22.96, 10.66, 6.14, and 60.00, respectively. The C/U of CUA for the above five methods were 302.16, 32.13, 19.30, 11.13, and 80.00, respectively. The MAUT value of the above five methods were 42.56, 5.00, 2.54, 1.63, and 12.56, respectively.ConclusionIn terms of CEA, CUA, and MAUT, the method D was the highest in economic value, which usually can be used as a routine method for detecting CPE, but it needs a long procedure time; thus, the method E can be used for rapid detection when clinical severe infection occurred, which is superior in both cost-effectiveness and rapidity.
ObjectiveTo understand the distribution characteristics and nosocomial infection of carbapenem-resistant Enterobacteriaceae (CRE) in a general hospital of traditional Chinese medicine, so as to provide the evidence for control and management of multidrug-resistant bacteria.MethodsData of CRE in the first Affiliated Hospital of Anhui University of Traditional Chinese Medicine were analyzed retrospectively from 2014 to 2018.ResultsThe total detection rate of CRE was 10.76%, 5.58%, 15.42%, 12.94% and 16.18% from 2014 to 2018, respectively. The detection rate of CRE showed a gradual upward trend (χ2=29.940, P<0.001). The highest number of CRE isolated from clinical specimens was sputum (355 strains, 63.39%), and the next were urine (98 strains, 17.50%) and secretions (38 strains, 6.79%). CRE isolated from different clinical departments were mainly in Neurosurgery Department (172 stains, 30.71%), Intensive Care Unit (Internal Medicine) (145 strains, 25.89%), Intensive Care Unit (Surgery)(106 strains,18.93%), and other internal medical departments (83 strains, 14.82%). A total of 179 patients developed CRE nosocomial infection in the past 5 years, who were mainly male, and with advanced age, long hospital stay, basic diseases, abnormal immune function and invasive operation. The incidence of hospital infection with CRE from 2014 to 2018 were 0.31‰, 0.38‰, 0.89‰, 0.80‰ and 1.14‰, respectively, which also showed a gradual upward trend (χ2=25.111, P<0.001).ConclusionWith the increasing number of clinically isolated CRE strains and the increasing incidence of nosocomial infection of CRE, effective intervention measures should be taken to prevent and control CRE.
ObjectiveTo analyze the drug-resistant phenotype and genotype characteristics of carbapenem-resistant Enterobacteriaceae (CRE) in a traditional Chinese medicine hospital from 2016 to 2018, to provide guidance for clinical rational drug use and effective anti-infection treatment.MethodsA total of 2 901 Enterobacteriaceae bacteria strains isolated from January 2016 to December 2018 were selected, and CRE strains were screened by microdilution test and Kirby-Bauer methods. CRE strains with successful seed preservation and detailed clinical data were selected for carbapenemase phenotype confirmation test, drug-resistant gene amplification, and sequencing comparison.ResultsThe 101 CRE strains collected between 2016 and 2018 were mainly Klebsiella pneumonia (73.27%, 74/101) and Escherichia coli (14.85%, 15/101), and the specimens were mainly from sputum (63.37%, 64/101) and catheter urine (11.88%, 12/101). The phenotypic test results of carbapenemase showed that 94 strains were positive in modified Hodge test, with a positive rate of 93.07%, 96 strains were positive in Carba NP test, with a positive rate of 95.05%, and 98 strains were positive in modified carbapenem inactivation method test, with a positive rate of 97.03%. Drug-resistant genes were detected in 92 (91.01%) of the 101 CRE strains, sequencing results showed that 66 (65.35%) carried blaKPC-2 gene, 4 (3.96%) carried blaKPC-19 gene, 9 (8.91%) carried blaNDM-1 gene, and 13 (12.87%) carried blaNDM-5 gene. No CRE strains carrying two resistance genes were detected. Among them, Klebsiella pneumoniae strains mainly carried blaKPC-2 gene (82.43%, 61/74), and Escherichia coli strains mainly carried blaNDM-5 gene (86.67%, 13/15), which were consistent with the main epidemic genotype in China.ConclusionsIn recent three years, the CRE strains in this hospital mainly included Klebsiella pneumoniae with blaKPC-2 gene and Escherichia coli with blaNDM-5 gene. According to the results of this test, we can reasonably select antimicrobial agents in combination with the drug sensitivity report from the microbial laboratory, so as to delay the growth of drug-resistant strains and prevent hospital transmission of multidrug-resistant bacteria.
ObjectiveTo study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.MethodsPatients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.ResultsA total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.ConclusionsThere are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.
ObjectiveTo evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.MethodsA retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.ResultsFrom 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ2trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ2=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ2=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ2=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ2=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).ConclusionAlthough the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.