Archive for September 8, 2015

Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae.

Emerg Infect Dis. 2015 Sep;21(9):1611-6.

Chea N, Bulens SN, Kongphet-Tran T, Lynfield R, Shaw KM, Vagnone PS, Kainer MA, Muleta DB, Wilson L, Vaeth E, Dumyati G, Concannon C, Phipps EC, Culbreath K, Janelle SJ, Bamberg WM, Guh AY, Limbago B, Kallen AJ.

Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority.

A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non-CP-CRE could help prevention efforts.

To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites.

We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase-producing Klebsiella isolates had been misclassified as non-CP.

A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%.

This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention.



September 8, 2015 at 3:55 pm

First report of emergence of OXA-48 carbapenemase-producing Enterobacteriaceae in Singapore: proactive or reactive infection control strategy?

Am J Infect Control. 2014 May;42(5):577-8.

Marimuthu K1, Teo JW2, Fong PB3, Chin JO3, Qi KJ3, Boon DL4, Ping AC3, Krishnan P3, Peng BA3.

1Tan Tock Seng Hospital, Singapore, and National University of Singapore, Singapore. Electronic address:

2National University Health System, Singapore.

3Tan Tock Seng Hospital, Singapore.

4Tan Tock Seng Hospital, Singapore, and National University Health System, Singapore.


September 8, 2015 at 3:54 pm

Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspectives on detection, treatment and infection control.

J Intern Med. 2015 May;277(5):501-12. .

Tängdén T1, Giske CG.

1Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.


The prevalence of carbapenem-resistant Gram-negative bacilli is on the rise worldwide, posing a major public health threat. Previously, this was mostly a problem in Pseudomonas and Acinetobacter, but during the last decade, carbapenem resistance has escalated in medically important species such as Klebsiella pneumoniae and Escherichia coli.

In particular, the rising trend in E. coli is of concern, as this may lead to almost untreatable community-acquired infections.

Resistance is conferred by carbapenemases, which are beta-lactamases that can breakdown essentially all beta-lactams.

Moreover, bacteria carrying these resistance determinants are often resistant to other treatment options, due to the frequent co-acquisition of non-beta-lactam resistance genes located on the same mobile genetic elements.

The detection of carbapenemase-producing Enterobacteriaceae (CPE) is a challenge, because some carbapenemases produce relatively discrete levels of carbapenem resistance.

Current clinical evidence for treatment guidance is limited and based on retrospective observational studies and case reports. Existing data support the use of combination therapy for treatment of severe infections caused by CPE.

Combination regimens including colistin, carbapenems, tigecycline, aminoglycosides and fosfomycin have been used. Randomized controlled studies of combination regimens are ongoing and may help to determine the optimal therapy.

Novel beta-lactamase inhibitors may also have a role in future treatment of these infections.

Strict infection control measures including isolation or cohort care of affected patients as well as contact tracing and active screening are needed to curb the spread of CPE.

In this review, we provide a clinical perspective on the management of patients infected or colonized with CPE.



September 8, 2015 at 3:52 pm

First Report of Klebsiella pneumoniae-Carbapenemase-3-Producing Escherichia coli ST479 in Poland.

Biomed Res Int. 2015;2015:256028.

Ojdana D1, Sacha P1, Olszańska D2, Majewski P1, Wieczorek P1, Jaworowska J2, Sieńko A1, Jurczak A2, Tryniszewska E1.

1Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269 Bialystok, Poland.

2Department of Microbiological Diagnostics and Infectious Immunology, University Hospital of Bialystok, 15a Waszyngtona Street, 15-269 Bialystok, Poland.


An increase in the antibiotic resistance among members of the Enterobacteriaceae family has been observed worldwide. Multidrug-resistant Gram-negative rods are increasingly reported.

The treatment of infections caused by Escherichia coli and other Enterobacteriaceae has become an important clinical problem associated with reduced therapeutic possibilities.

Antimicrobial carbapenems are considered the last line of defense against multidrug-resistant Gram-negative bacteria.

Unfortunately, an increase of carbapenem resistance due to the production of Klebsiella pneumoniae carbapenemase (KPC) enzymes has been observed.

In this study we describe the ability of E. coli to produce carbapenemase enzymes based on the results of the combination disc assay with boronic acid performed according to guidelines established by the European Community on Antimicrobial Susceptibility Testing (EUCAST) and the biochemical Carba NP test.

Moreover, we evaluated the presence of genes responsible for the production of carbapenemases (bla KPC, bla VIM, bla IMP, bla OXA-48) and genes encoding other β-lactamases (bla SHV, bla TEM, bla CTX-M) among E. coli isolate.

The tested isolate of E. coli that possessed the bla KPC-3 and bla TEM-34 genes was identified. The tested strain exhibited susceptibility to colistin (0.38 μg/mL) and tigecycline (1 μg/mL).

This is the first detection of bla KPC-3 in an E. coli ST479 in Poland.


September 8, 2015 at 8:53 am


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