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carbapenem-resistant Enterobacteriaceae (CRE)

Epidemiology: - cluster of Verona integron-encoded metallo-beta-lactamase- producing carbapenem-resistant Enterobacteriaceae identified by active surveillance (perirectal cultures), Kentucky 2015 [3] - 6 patients, including neonates in NICU, were colonized with 4 species total but had no symptoms [3] - carbapenem-resistant P. aeruginosa from medical tourism (U.S. residents obtaining surgical procedures in Mexico [7] Pathology: - difficult to eradicate drug-resistant bacteria that contaminates endoscopes used for duododenoscopy (ERCP)* * the design of the scopes Laboratory: - Enterobacteriaceae carbapenemase-resistant identified by culture - carbapenemase resistance gene - carbapenemase in stool - carbapenemase in isolate Complications: - septicemia due to CRE associated with 40-50% mortality Management: - treatment with ceftolozane tazobactam plus colistin [5,6] - prevention: - 48 hour quarantine post decontamination to allow for bacterial cultures before reusing endoscopes

Related

carbapenem (thienamycin) Enterobacterales

General

Enterobacteriaceae

References

  1. Terhune C Superbug linked to 2 deaths at UCLA hospital; 179 potentially exposed. The Los Angeles Times. Feb 19, 2015
  2. FDA MedWatch. Feb 19, 2015 Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes: FDA Safety Communication - Design May Impede Effective Cleaning. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm434922.htm
  3. Yaffee AQ, Roser L, Daniels K et al Notes from the Field: Verona Integron-Encoded Metallo-Beta- Lactamase-Producing Carbapenem-Resistant Enterobacteriaceae in a Neonatal and Adult Intensive Care Unit - Kentucky, 2015. MMWR Weekly / February 26, 2016 / 65(7);190 http://www.cdc.gov/mmwr/volumes/65/wr/mm6507a5.htm
  4. Centers for Disease Control & Prevention (CDC) Healthcare-associated Infections (HAIs) Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) - November 2015 Update CRE Toolkit. http://www.cdc.gov/hai/organisms/cre/cre-toolkit/
  5. Morrill HJ, Pogue JM, Kaye KS, LaPlante KL. Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections. Open Forum Infect Dis. 2015 May 5;2(2):ofv050. Review. PMID: 26125030 Free PMC Article
  6. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  7. Kracalik I, Ham C, Smith AR, et al. Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa infections in U.S. residents associated with invasive medical procedures in Mexico, 2015-2018. MMWR Morb Mortal Wkly Rep 2019 May 24; 68:463-464 https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a4.htm