Kayoko Hayakawa1, Ryuichi Nakano2, Ryota Hase3, Michitsugu Shimatani4, Hideaki Kato5, Jumpei Hasumi6, Asako Doi7, Noritaka Sekiya8, Takahito Nei9, Keiji Okinaka10, Kei Kasahara11, Hanako Kurai12, Maki Nagashima1, Tohru Miyoshi-Akiyama13, Risako Kakuta2, Hisakazu Yano2, Norio Ohmagari1. 1. Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. 2. Department of Microbiology and Infectious Diseases, Nara Medical University, Nara, Japan. 3. Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, Japan. 4. Department of Infectious Diseases and Infection Control, Hamamatsu Medical Center, Shizuoka, Japan. 5. Infection Prevention and Control Department, Yokohama City University Hospital, Kanagawa, Japan. 6. Department of Pediatrics, Saku Medical Center, Nagano, Japan. 7. Division of Infectious Diseases, Kobe City Medical Center General Hospital, Hyogo, Japan. 8. Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 9. Department of Infection Prevention and Control, Nippon Medical School Hospital, Tokyo, Japan. 10. Division of General Internal Medicine, National Cancer Center Hospital East, Chiba, Japan. 11. Center for Infectious Diseases, Nara Medical University, Nara, Japan. 12. Division of Infectious Diseases, Shizuoka Cancer Center, Shizuoka, Japan. 13. Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase. OBJECTIVES: We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE. METHODS: Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis. RESULTS: Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group. CONCLUSIONS: IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE.
BACKGROUND:Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase. OBJECTIVES: We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE. METHODS:Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis. RESULTS: Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group. CONCLUSIONS: IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE.
Authors: William C Shropshire; Samuel L Aitken; Reed Pifer; Jiwoong Kim; Micah M Bhatti; Xiqi Li; Awdhesh Kalia; Jessica Galloway-Peña; Pranoti Sahasrabhojane; Cesar A Arias; David E Greenberg; Blake M Hanson; Samuel A Shelburne Journal: J Antimicrob Chemother Date: 2021-01-19 Impact factor: 5.790