Volume 21, Number 11—November 2015
Research
Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012
Table 3
Drug class or drug | No. nonsusceptible/no. tested (%) |
---|---|
Aminoglycosides | 139/266 (52.26) |
Gentamicin | 108/265 (40.75) |
Tobramycin | 116/235 (49.36) |
Amikacin | 49/230 (21.30) |
β-lactam/β-lactamase inhibitors | 236/249 (94.78) |
Ampicillin/sulbactam† | 188/194 (96.91) |
Piperacillin/tazobactam | 201/231 (87.01) |
Cefepime | 125/241 (51.87) |
Ciprofloxacin | 122/253 (48.22) |
Trimethoprim/sulfamethoxazole | 142/263 (53.99) |
Multidrug resistant‡ | 127/263 (48.29) |
*Rows showing drug classes (aminoglycosides, β-lactam/β-lactamase inhibitors) indicate number of isolates that were tested against >1 drug listed in the class and the number of isolates that were nonsusceptible to >1 drug listed in the class. Tigecycline susceptibility test results were not recorded in the database. Polymyxin B and colistin susceptibility test results were recorded in the database, but none of the carbapenem-resistant Enterobacteriaceae (CRE) isolates were tested against those drugs. Only 1 CRE-positive isolate was tested against fosfomycin. CRE is defined as resistance to all tested third-generation cephalosporins (ceftriaxone, cefotaxime, or ceftazidime), and nonsusceptiblity to >1 carbapenem (ertapenem, imipenem, meropenem, or doripenem). For bacteria with intrinsic imipenem nonsusceptibility (P. mirabilis), the CRE criteria required nonsusceptibility to >2 of the carbapenems listed.
†Citrobacter (n = 8) and Enterobacter (n = 98) species are intrinsically resistant (22) to ampicillin/sulbactam. However, they have been included in the table.
‡These CRE isolates were nonsusceptible to >1 drug from each of the following 3 drug classes: aminoglycosides (gentamicin, tobramycin, amikacin), β-lactams (ampicillin/sulbactam, piperacillin/tazobactam), fluoroquinolones (ciprofloxacin), and trimethoprim/sulfamethoxazole.
References
- Bush K, Fisher JF. Epidemiological expansion, structural studies, and clinical challenges of new β-lactamases from gram-negative bacteria. Annu Rev Microbiol. 2011;65:455–78 . DOIPubMedGoogle Scholar
- Bush K, Jacoby GA. Updated functional classification of β-lactamases. Antimicrob Agents Chemother. 2010;54:969–76. DOIPubMedGoogle Scholar
- Doi Y, Park YS, Rivera JI, Adams-Haduch JM, Hingwe A, Sordillo EM, Community-associated extended-spectrum β-lactamase–producing Escherichia coli infection in the United States. Clin Infect Dis. 2013;56:641–8. DOIPubMedGoogle Scholar
- Lukac PJ, Bonomo RA, Logan LK. Extended-spectrum β-lactamase-producing Enterobacteriaceae in children: old foe, emerging rhreat. Clin Infect Dis. 2015;60:1389–97 .PubMedGoogle Scholar
- Pitout JD, Laupland KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8:159–66. DOIPubMedGoogle Scholar
- Munoz‐Price LS, Quinn JP. The spread of Klebsiella pneumoniae carbapenemases: a tale of strains, plasmids, and transposons. Clin Infect Dis. 2009;49:1739–41. DOIPubMedGoogle Scholar
- Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010;10:597–602. DOIPubMedGoogle Scholar
- Mathers AJ, Hazen KC, Carroll J, Yeh AJ, Cox HL, Bonomo RA, First clinical cases of OXA-48–producing carbapenem-resistant Klebsiella pneumoniae in the United States: the “menace” arrives in the new world. J Clin Microbiol. 2013;51:680–3. DOIPubMedGoogle Scholar
- Logan LK. Carbapenem-resistant Enterobacteriaceae: an emerging problem in children. Clin Infect Dis. 2012;55:852–9. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention (CDC). Vital signs: carbapenem-resistant Enterobacteriaceae. Report no. 62, Mar 2013 [cited 2014 Aug 21]. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6209a3.htm
- Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, Sep 2013 [cited 2014 Aug 21]. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
- Castanheira M, Farrell SE, Deshpande LM, Mendes RE, Jones RN. Prevalence of β-lactamase-encoding genes among Enterobacteriaceae bacteremia isolates collected in 26 U.S. hospitals: report from the SENTRY Antimicrobial Surveillance Program (2010). Antimicrob Agents Chemother. 2013;57:3012–20. DOIPubMedGoogle Scholar
- Lin MY, Lyles-Banks RD, Lolans K, Hines DW, Spear JB, Petrak R, The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis. 2013;57:1246–52 . DOIPubMedGoogle Scholar
- Braykov NP, Eber M, Klein E, Morgan D, Laxminarayan RM. Trends in resistance to carbapenems and third-generation cephalosporins among clinical isolates of Klebsiella pneumoniae in the United States, 1999–2010. Infect Control Hosp Epidemiol. 2013;34:259–68. DOIPubMedGoogle Scholar
- Little ML, Qin X, Zerr DM, Weissman SJ. Molecular diversity in mechanisms of carbapenem resistance in paediatric Enterobacteriaceae. Int J Antimicrob Agents. 2012;39:52–7. DOIPubMedGoogle Scholar
- Viau RA, Hujer AM, Marshall SH, Perez F, Hujer KM, Briceno DF, “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in northeast Ohio. Clin Infect Dis. 2012;54:1314–21. DOIPubMedGoogle Scholar
- Hoffmann MS, Eber MR, Laxminarayan R. Increasing resistance of Acinetobacter species to imipenem in United States Hospitals, 1999. Infect Control Hosp Epidemiol. 2010;31:196–7. DOIPubMedGoogle Scholar
- Klein E, Smith DL, Laxminarayan R. Community-associated methicillin-resistant Staphylococcus aureus in outpatients, United States, 1999–2006. Emerg Infect Dis. 2009;15:1925–30 . DOIPubMedGoogle Scholar
- Logan LK, Braykov NP, Weinstein RA, Laxminarayan R. Extended-spectrum β-lactamase–producing and third-generation cephalosporin-resistant Enterobacteriaceae in children: trends in the United States, 1999–2011. Journal of the Pediatric Infectious Diseases Society. 2014;3:320–8. DOIGoogle Scholar
- Centers for Disease Control and Prevention. CDC 2012 CRE toolkit: guidance for control of carbapenem-resistant Enterobacteriaceae (CRE) [cited 2014 Jun 25]. http://www.cdc.gov/hai/organisms/cre/cre-toolkit/background.html
- R Development Core Team. R: a language and environment for statistical computing, 2013. Vienna: R Foundation for Statistical Computing [cited 2015 Jun 23]. http://www.R-project.org
- Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance: international standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81. DOIPubMedGoogle Scholar
- Falagas ME, Karageorgopoulos DE, Nordmann P. Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes. Future Microbiol. 2011;6:653–66. DOIPubMedGoogle Scholar
- Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis. 2011;53:60–7. DOIPubMedGoogle Scholar
- Gasink LB, Edelstein PH, Lautenbach E, Synnestvedt M, Fishman NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae. Infect Control Hosp Epidemiol. 2009;30:1180–5. DOIPubMedGoogle Scholar
- Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem‐resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29:1099–106. DOIPubMedGoogle Scholar
- Tuon FF, Rocha JL, Toledo P, Arend LN, Dias CH, Leite TM, Risk factors for KPC-producing Klebsiella pneumoniae bacteremia. Braz J Infect Dis. 2012;16:416–9. DOIPubMedGoogle Scholar
- Mouloudi E, Protonotariou E, Zagorianou A, Iosifidis E, Karapanagiotou A, Giasnetsova T, Bloodstream infections caused by metallo–β‐lactamase/Klebsiella pneumoniae carbapenemase–producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol. 2010;31:1250–6 . DOIPubMedGoogle Scholar
- Hsu AJ, Tamma PD. Treatment of multidrug-resistant gram-negative infections in children. Clin Infect Dis. 2014;58:1439–48. DOIPubMedGoogle Scholar
- US Food and Drug Administration. Drug safety and availability. FDA drug safety communication: FDA warns of increased risk of death with IV antibacterial Tygacil (tigecycline) and approves new boxed warning [cited 2014 Sep 10]. http://www.fda.gov/drugs/drugsafety/ucm369580.htm
- Haertl R, Bandlow G. Epidemiological fingerprinting of Enterobacter cloacae by small-fragment restriction endonuclease analysis and pulsed-field gel electrophoresis of genomic restriction fragments. J Clin Microbiol. 1993;31:128–33 .PubMedGoogle Scholar
- Stumpf AN, Roggenkamp A, Hoffmann H. Specificity of enterobacterial repetitive intergenic consensus and repetitive extragenic palindromic polymerase chain reaction for the detection of clonality within the Enterobacter cloacae complex. Diagn Microbiol Infect Dis. 2005;53:9–16. DOIPubMedGoogle Scholar
- Miyoshi-Akiyama T, Hayakawa K, Ohmagari N, Shimojima M, Kirikae T. Multilocus sequence typing (MLST) for characterization of Enterobacter cloacae. PLoS ONE. 2013;8:e66358 . DOIPubMedGoogle Scholar
- Viau RA, Kiedrowski L, Perez F, Marchaim D, Guerrero D, Kaye K, K-1676: outbreak analysis of Enterobacter cloacae: hsp60 compares favorably to rep-PCR. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; 2014 Sep 8; Washington, DC [cited 2015 Jun 23]. http://www.icaaconline.com/php/icaac2014abstracts/data/papers/2014/K-1676.htm
- Stillwell T, Green M, Barbadora K, Ferrelli JG, Roberts TL, Weissman SJ, Outbreak of KPC-3 producing carbapenem-resistant Klebsiella pneumoniae in a US pediatric hospital. Journal of the Pediatric Infectious Diseases Society. 2014;3:1–9.
- Giuffrè M, Bonura C, Geraci DM, Saporito L, Catalano R, Di Noto S, Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy. J Hosp Infect. 2013;85:233–6 . DOIPubMedGoogle Scholar
- Löhr IH, Rettedal S, Natas OB, Naseer U, Oymar K, Sundsfjord A. Long-term faecal carriage in infants and intra-household transmission of CTX-M-15-producing Klebsiella pneumoniae following a nosocomial outbreak. J Antimicrob Chemother. 2013;68:1043–8. DOIPubMedGoogle Scholar
- Zerr DM, Qin X, Oron AP, Adler AL, Wolter DJ, Berry JE, Pediatric infection and intestinal carriage due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2014;58:3997–4004. DOIPubMedGoogle Scholar