دورية أكاديمية
Incidence of a subsequent carbapenem-resistant Enterobacteriaceae infection after previous colonisation or infection: a prospective cohort study.
| العنوان: | Incidence of a subsequent carbapenem-resistant Enterobacteriaceae infection after previous colonisation or infection: a prospective cohort study. |
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| المؤلفون: | Tang SSL; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, Singapore., Chee E; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, Singapore., Teo JQ; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore., Chlebicki MP; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore., Kwa ALH; Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, Singapore; Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore; Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore. Electronic address: andrea.kwa.l.h@sgh.com.sg. |
| المصدر: | International journal of antimicrobial agents [Int J Antimicrob Agents] 2021 Jun; Vol. 57 (6), pp. 106340. Date of Electronic Publication: 2021 Apr 20. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Publishers Country of Publication: Netherlands NLM ID: 9111860 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-7913 (Electronic) Linking ISSN: 09248579 NLM ISO Abbreviation: Int J Antimicrob Agents Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Amsterdam : Elsevier Science Publishers, c1991- |
| مواضيع طبية MeSH: | Anti-Bacterial Agents/*pharmacology , Carbapenem-Resistant Enterobacteriaceae/*drug effects , Carbapenem-Resistant Enterobacteriaceae/*isolation & purification , Enterobacteriaceae Infections/*epidemiology , Enterobacteriaceae Infections/*microbiology, Aged ; Aged, 80 and over ; Carbapenems/pharmacology ; Carrier State/microbiology ; Drug Resistance, Bacterial ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intraabdominal Infections/microbiology ; Lung/microbiology ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prospective Studies ; Rectum/microbiology ; Recurrence ; Risk Factors ; Singapore/epidemiology ; Skin/microbiology ; Tertiary Care Centers ; Urine/microbiology |
| مستخلص: | Objectives: In patients with a history of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE), the need for CP-CRE targeted treatment in subsequent sepsis episodes is unclear. This study aimed to characterise the incidence of subsequent CP-CRE infective episodes in individuals with prior CP-CRE colonisation and/or infection, and identify predictors for these subsequent CP-CRE infections. Methods: All adult inpatients with CP-CRE detected from any site between June 2012 and May 2014 at a tertiary-care hospital were prospectively followed for two years to assess for any subsequent CP-CRE infections. Potential factors to which patients were exposed during the follow-up period were collected from medical records and analysed. Results: A total of 171 patients were enrolled. Of 151 patients who entered the follow-up period, 16 (10.6%) developed a subsequent CP-CRE infection. The median time to a subsequent infective episode was 24.5 days (12-105 days). The type of carbapenemase was highly conserved within index and subsequent paired episodes (16 of 17 pairs). Patients with first CP-CRE isolated from intra-abdominal or respiratory sources were ≥7 times more likely to develop a subsequent infection, while most rectal carriers remain colonised. For carriers (n = 133), Klebsiella spp. (OR 4.7) and OXA carbapenemase (OR 9.4) were significant predictors of subsequent infection. In patients with initial infection (n = 18), end-stage renal failure requiring dialysis (OR 22.0) was the only predisposing factor. Conclusion: The incidence of subsequent infections in patients with prior colonisation was low. Consideration for CP-CRE targeted therapy is recommended in patients on dialysis and previous CP-CRE infections involving the bloodstream and/or respiratory tract. (Copyright © 2021. Published by Elsevier Ltd.) |
| فهرسة مساهمة: | Keywords: Carbapenem-resistant Enterobacteriaceae; Carbapenemase-producing; Colonisation; Infection; Risk factors |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) 0 (Carbapenems) |
| تواريخ الأحداث: | Date Created: 20210415 Date Completed: 20211004 Latest Revision: 20211004 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.ijantimicag.2021.106340 |
| PMID: | 33857538 |
| قاعدة البيانات: | MEDLINE |
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