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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
  • 6,522 View
  • 317 Download
  • 9 Web of Science
  • 12 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
  • Investigation of Intestinal Colonization and Infection of Carbapenem Resistant Enterobacteriaceae in Intensive Care Unit Patients and Analysis of Influencing Factors
    丽红 王
    Advances in Clinical Medicine.2024; 14(05): 315.     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 Article
Infection
Intensive Care Unit Relocation and Its Effect on Multidrug-Resistant Respiratory Microorganisms
Hyung-Jun Kim, EuiSeok Jeong, Pyoeng Gyun Choe, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2018;33(4):238-245.   Published online November 14, 2018
DOI: https://doi.org/10.4266/acc.2018.00220
  • 5,616 View
  • 100 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes.
Methods
Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured.
Results
A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days).
Conclusions
Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.

Citations

Citations to this article as recorded by  
  • A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B
    Laura Brunelli, Edoardo Miotto, Massimo Del Pin, Daniele Celotto, Adriana Moccia, Gianni Borghi, Amato De Monte, Cristiana Macor, Roberto Cocconi, Luca Lattuada, Silvio Brusaferro, Luca Arnoldo
    Frontiers in Medicine.2023;[Epub]     CrossRef
Case Report
Infection/Pulmonary
Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii
Hwa Young Lee, Hea Yon Lee, Sae Bom Shin, Kab Soo Shin, Bong Woo Lee, Hwan Wook Kim, Seok Lee, Seok Chan Kim
Korean J Crit Care Med. 2015;30(2):103-108.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.103
  • 4,925 View
  • 47 Download
AbstractAbstract PDF
Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.
Original Article
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
  • 6,160 View
  • 67 Download
  • 1 Crossref
AbstractAbstract 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

ACC : Acute and Critical Care