دورية أكاديمية
Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore.
| العنوان: | Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore. |
|---|---|
| المؤلفون: | Marimuthu K; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore., Venkatachalam I; Department of Infectious Diseases, Singapore General Hospital., Khong WX; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore., Koh TH; Department of Pathology, Singapore General Hospital., Cherng BPZ; Department of Infectious Diseases, Singapore General Hospital., Van La M; National Public Health Laboratory, Ministry of Health of Singapore., De PP; Department of Laboratory Medicine, Tan Tock Seng Hospital.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore., Krishnan PU; National Public Health Laboratory, Ministry of Health of Singapore.; Department of Laboratory Medicine, Tan Tock Seng Hospital.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore., Tan TY; Department of Laboratory Medicine, Changi General Hospital, Singapore., Choon RFK; Division of Infectious Diseases, Department of Medicine, Changi General Hospital, Singapore., Pada SK; Department of Infectious Diseases, Ng Teng Fong General Hospital, Singapore., Lam CW; Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore., Ooi ST; Department of Infectious Diseases, Khoo Teck Puat Hospital, Singapore., Deepak RN; Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore., Smitasin N; Division of Infectious Diseases, National University Hospital, Singapore., Tan EL; Centre of Biomedical and Life Sciences, Singapore Polytechnic., Lee JJ; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore., Kurup A; Mount Elizabeth Hospital, Singapore., Young B; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore., Sim NTW; Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore., Thoon KC; Yong Loo Lin School of Medicine, National University of Singapore.; Department of Pediatrics, KK Women's and Children's Hospital, Singapore., Fisher D; Yong Loo Lin School of Medicine, National University of Singapore.; Division of Infectious Diseases, National University Hospital, Singapore., Ling ML; Department of Infection Prevention and Control, Singapore General Hospital., Peng BAS; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore., Teo YY; Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore.; NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS).; Department of Statistics & Applied Probability, Faculty of Science, National University of Singapore.; Life Sciences Institute, National University of Singapore.; Genome Institute of Singapore., Hsu LY; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.; Saw Swee Hock School of Public Health, National University Health System., Lin RTP; National Public Health Laboratory, Ministry of Health of Singapore.; Department of Laboratory Medicine, National University Hospital, Singapore., Ong RT; Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore., Teo J; Department of Laboratory Medicine, National University Hospital, Singapore., Ng OT; Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. |
| مؤلفون مشاركون: | Carbapenemase-Producing Enterobacteriaceae in Singapore (CaPES) Study Group |
| المصدر: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2017 May 15; Vol. 64 (suppl_2), pp. S68-S75. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Jan. 2011- : Oxford : Oxford University Press Original Publication: Chicago, IL : The University of Chicago Press, c1992- |
| مواضيع طبية MeSH: | Inpatients*, Carbapenem-Resistant Enterobacteriaceae/*genetics , Cross Infection/*epidemiology , Enterobacteriaceae Infections/*epidemiology, Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Carbapenem-Resistant Enterobacteriaceae/drug effects ; Carbapenem-Resistant Enterobacteriaceae/isolation & purification ; Carbapenems/pharmacology ; Carbapenems/therapeutic use ; DNA, Bacterial/genetics ; Electronic Health Records ; Enterobacter cloacae/genetics ; Enterobacter cloacae/isolation & purification ; Enterobacteriaceae Infections/microbiology ; Enterobacteriaceae Infections/transmission ; Escherichia coli/genetics ; Escherichia coli/isolation & purification ; Escherichia coli Infections/epidemiology ; Female ; Genome, Bacterial ; High-Throughput Nucleotide Sequencing ; Humans ; Incidence ; Klebsiella Infections/epidemiology ; Klebsiella pneumoniae/genetics ; Klebsiella pneumoniae/isolation & purification ; Male ; Surveys and Questionnaires ; Young Adult ; beta-Lactam Resistance ; beta-Lactamases/biosynthesis ; beta-Lactamases/genetics |
| مستخلص: | Background: Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods: Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE were estimated based on mandatory data submitted to the National Public Health Laboratory by public hospitals between 2010 and 2015. CRE-positive adult inpatients were prospectively recruited from 6 public sector hospitals between December 2013 and April 2015. Subjects answered a standardized epidemiologic questionnaire and provided samples for this study. Further clinical information was extracted from subjects' electronic medical records. Whole-genome sequencing was performed on study isolates to determine transmission clusters. Results: Incidence of CRE clinical cultures among adult inpatients plateaued from 2013 (range: 7.73 to 10.32 per 100000 patient-days) following an initial increase between 2010 and end-2012. We prospectively recruited 249 subjects. Their median age was 65 years, 108 (43%) were female, and 161 (64.7%) had carbapenemase-producing Enterobacteriaceae (CPE). On multivariate analysis, prior carbapenem exposure (OR: 3.23; 95% CI: 1.67-6.25) and hematological malignancies (OR: 2.85; 95% CI: 1.10-7.41) were associated with non-carbapenemase-producing CRE (NCPE) (n = 88) compared with CPE (n = 161) subjects. Among 430 CRE isolates from the 249 subjects, 307(71.3%) were CPE, of which 154(50.2%) were blaKPC-positive, 97(31.6%) blaNDM-positive, and 42 (13.7%) blaOXA-positive. Klebsiella pneumoniae (n = 180, 41.9%), Escherichia coli (n = 129, 30.0%) and Enterobacter cloacae (n = 62, 14.4%) were the main Enterobacteriaceae species. WGS (n = 206) revealed diverse bacterial strain type (STs). The predominant blaKPC-positive plasmid was pHS102707 (n = 62, 55.4%) and the predominant blaNDM-positive plasmid was pNDM-ECS01 (n = 46, 48.9%). Five transmission clusters involving 13 subjects were detected. Conclusions: Clinical CRE trend among adult inpatients showed stabilization following a rapid rise since introduction in 2010 potentially due to infection prevention measures and antimicrobial stewardship. More work is needed on understanding CPE transmission dynamics. (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.) |
| فهرسة مساهمة: | Keywords: antimicrobial resistance.; carbapenem-resistant Enterobacteriaceae; epidemiology; whole-genome sequencing |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) 0 (Carbapenems) 0 (DNA, Bacterial) EC 3.5.2.6 (beta-Lactamases) |
| تواريخ الأحداث: | Date Created: 20170506 Date Completed: 20180124 Latest Revision: 20220408 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1093/cid/cix113 |
| PMID: | 28475792 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1537-6591 |
|---|---|
| DOI: | 10.1093/cid/cix113 |