Carbapenem resistance in Enterobacteriaceae nearly quadrupled in the last decade, new study finds

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1. Carbapenem resistance in Enterobacteriaceae increased from 1.2% in 2001 to 4.2% in 2011.

2. Klebsiella had the highest increase in carbapenem resistance. 

3. Most CRE infections are acquired in hospitals.

Carbapenem-Resistant Enterobacteriaceae (CRE) have become an increasingly recognized cause of community-acquired and hospital-acquired infections in the United States.  Infections associated with CRE yield mortality rates exceeding 40%.  The results from this study suggest a disturbingly high increase in the rate of resistance to carbapenem antibiotics among the species of Enterobacteriaceae in the last decade.  Between 2001 and 2011, the percentage of Enterobacteriaceae resistant to carbapenems grew by nearly four times, from 1.2% to 4.2%.  It also appears as though most of the infections were hospital acquired, either from urinary catheters or intravenous catheters and central lines.  While the study was certainly not all inclusive, it spanned several databases and covered multiple sites around the United States to give a reasonable glimpse at the epidemiology of these pathogens.  Given the increasing rate of CRE, further attention will need to be directed toward proper utilization of beta-lactams against Enterobacteriaceae, as well as minimizing hospital-acquired infections, and the development of new antimicrobials.

Click to read the study in MMWR

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Image: PD

1. Carbapenem resistance in Enterobacteriaceae increased from 1.2% in 2001 to 4.2% in 2011.

2. Klebsiella had the highest increase in carbapenem resistance.

3. Most CRE infections are acquired in hospitals.

This [restrospective] study investigated the national incidence of Carbapenem-Resistant Enterobacteriaceae (CRE) between 2001 and 2011.  The study analyzed data from the National Healthcare Safety Network database, the National Nosocomial Infection Surveillance system and the Surveillance Network-USA to identify cases of hospital-acquired infections involving CRE isolates (E.coli, Klebsiella, and Enterobacter species).  Data from the CDC’s Emerging Infections Program were used to corroborate whether identified cases were hospital-associated.  According to the study, the proportion of Enterobacteriaceae that were carbapenem-resistant was 1.2% In 2001, and 4.2% in 2011.  Klebsiella species yielded the highest increase in carbapenem resistance, from 1.6% to 10.4%.  The most common sites of infection were the urinary tract (89%) and blood (10%).  72% of patients with positive CRE cultures had been recently hospitalized.

In sum: Carbapenem-Resistant Enterobacteriaceae (CRE) have become an increasingly recognized cause of community-acquired and hospital-acquired infections in the United States.  Infections associated with CRE yield mortality rates exceeding 40%.  The results from this study suggest a disturbingly high increase in the rate of resistance to carbapenem antibiotics among the species of Enterobacteriaceae in the last decade.  Between 2001 and 2011, the percentage of Enterobacteriaceae resistant to carbapenems grew by nearly four times, from 1.2% to 4.2%.  It also appears as though most of the infections were hospital acquired, either from urinary catheters or intravenous catheters and central lines.  While the study was certainly not all inclusive, it spanned several databases and covered multiple sites around the United States to give a reasonable glimpse at the epidemiology of these pathogens.  Given the increasing rate of CRE, further attention will need to be directed toward proper utilization of beta-lactams against Enterobacteriaceae, as well as minimizing hospital-acquired infections, and the development of new antimicrobials.

Click to read the study in MMWR

By Akira Shisido and Mitalee Patil

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