Acute and Critical Care

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

10,396 View
213 Download
3 Web of Science
3 Crossref

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

Infection
Surveillance of Extended-Spectrum β-Lactamase-producing Enterobacteriaceae Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis: Yasumasa Kawano, Takeshi Nishida, Atsushi Togawa, Yuhei Irie, Kota Hoshino, Norihiko Matsumoto, Hiroyasu Ishikura; Korean J Crit Care Med. 2016;31(4):317-323. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00703

8,230 View
140 Download
1 Crossref

Abstract PDF

Background
The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation.
Methods
We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2.
Results
We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/ piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively).
Conclusions
Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.

Citations

Citations to this article as recorded by

Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Carriage in Patients Admitted to Intensive Care Unit in a Tertiary Care Hospital in Thailand
Anong Kiddee, Kanit Assawatheptawee, Anamai Na-udom, Pratya Boonsawang, Pornpit Treebupachatsakul, Timothy R. Walsh, Pannika R. Niumsup
Microbial Drug Resistance.2019; 25(8): 1182. CrossRef

Infection
Extended-Spectrum beta-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit: Bumjoon Kim, Sung Gyun Kim, Seung Soon Lee, Tae Seok Kim, Yong Il Hwang, Seung Hun Jang, Joo Hee Kim, Ki Suck Jung, Sunghoon Park; Korean J Crit Care Med. 2014;29(4):257-265. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.257

6,043 View
67 Download
1 Crossref

Abstract PDF

BACKGROUND
The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting.
METHODS
Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome.
RESULTS
In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production.
CONCLUSIONS
Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.

Citations

Citations to this article as recorded by

Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case–control study
Franco Castillo-Tokumori, Claudia Irey-Salgado, Germán Málaga
International Journal of Infectious Diseases.2017; 55: 16. CrossRef

First
Prev
Page of 1
Next
Last

Search