Effect of varying federal definitions on prevalence and characteristics associated with carbapenem-resistant Enterobacteriaceae in veterans with spinal cord injury.
Aged
Carbapenem-Resistant Enterobacteriaceae
/ drug effects
Enterobacter
/ drug effects
Enterobacteriaceae Infections
/ epidemiology
Escherichia coli
/ drug effects
Female
Humans
Klebsiella
/ drug effects
Male
Microbial Sensitivity Tests
Middle Aged
Prevalence
Retrospective Studies
Spinal Cord Injuries
/ complications
Veterans
Epidemiology
Multidrug-resistant bacteria
Surveillance
Journal
American journal of infection control
ISSN: 1527-3296
Titre abrégé: Am J Infect Control
Pays: United States
ID NLM: 8004854
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
15
05
2018
revised:
01
08
2018
accepted:
01
08
2018
pubmed:
12
10
2018
medline:
5
3
2020
entrez:
11
10
2018
Statut:
ppublish
Résumé
Patients with spinal cord injury (SCI) have a high risk for multidrug-resistant organisms, including carbapenem-resistant Enterobacteriaceae (CRE). Accurate and easily applied definitions are critical to identify CRE. This study describes CRE and associated characteristics in veterans with SCI per Centers for Disease Control and Prevention (CDC) and Department of Veterans Affairs (VA) definitions. A retrospective cohort of veterans with SCI and more than 1 culture with Escherichia coli, Klebsiella spp and/or Enterobacter spp between 2012 and 2013 was examined. Antibiotic susceptibility criteria of pre-2015 (CDC1) and post-2015 (CDC2) CDC definitions and pre-2017 (VA1) and post-2017 (VA2) VA definitions were used to identify CRE. CRE prevalence and characteristics are described for isolates meeting each definition, and agreement was assessed with the Cohen kappa. We reviewed 21,514 isolates cultured from 6,974 veterans; 423 isolates met any CRE definition. Although agreement among definitions was high (kappa = 0.82-0.93), definitions including ertapenem resistance led to higher CRE prevalence (VA1 = 1.7% and CDC2 = 1.9% vs VA2 = 1.4% and CDC1 = 1.5%). Forty-four of 142 VA facilities had more than 1 CRE case defined by VA2; 10 facilities accounted for 60% of CRE cases. Almost all CRE was isolated from high-complexity, urban facilities, and the South had the highest proportion of CRE. Varying federal definitions give different CRE frequencies in a high-risk population. Definitions including ertapenem resistance resulted in higher CRE prevalence but may overemphasize noncarbapenemase isolates. Thus, both federal definitions now highlight the importance of carbapenemase testing.
Sections du résumé
BACKGROUND
Patients with spinal cord injury (SCI) have a high risk for multidrug-resistant organisms, including carbapenem-resistant Enterobacteriaceae (CRE). Accurate and easily applied definitions are critical to identify CRE. This study describes CRE and associated characteristics in veterans with SCI per Centers for Disease Control and Prevention (CDC) and Department of Veterans Affairs (VA) definitions.
METHODS
A retrospective cohort of veterans with SCI and more than 1 culture with Escherichia coli, Klebsiella spp and/or Enterobacter spp between 2012 and 2013 was examined. Antibiotic susceptibility criteria of pre-2015 (CDC1) and post-2015 (CDC2) CDC definitions and pre-2017 (VA1) and post-2017 (VA2) VA definitions were used to identify CRE. CRE prevalence and characteristics are described for isolates meeting each definition, and agreement was assessed with the Cohen kappa.
RESULTS
We reviewed 21,514 isolates cultured from 6,974 veterans; 423 isolates met any CRE definition. Although agreement among definitions was high (kappa = 0.82-0.93), definitions including ertapenem resistance led to higher CRE prevalence (VA1 = 1.7% and CDC2 = 1.9% vs VA2 = 1.4% and CDC1 = 1.5%). Forty-four of 142 VA facilities had more than 1 CRE case defined by VA2; 10 facilities accounted for 60% of CRE cases. Almost all CRE was isolated from high-complexity, urban facilities, and the South had the highest proportion of CRE.
CONCLUSIONS
Varying federal definitions give different CRE frequencies in a high-risk population. Definitions including ertapenem resistance resulted in higher CRE prevalence but may overemphasize noncarbapenemase isolates. Thus, both federal definitions now highlight the importance of carbapenemase testing.
Identifiants
pubmed: 30301655
pii: S0196-6553(18)30825-3
doi: 10.1016/j.ajic.2018.08.001
pmc: PMC8575162
mid: NIHMS1744787
pii:
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
175-179Subventions
Organisme : RRD VA
ID : I21 RX001583
Pays : United States
Organisme : HSRD VA
ID : IK6 HX003156
Pays : United States
Informations de copyright
Published by Elsevier Inc.
Références
Clin Infect Dis. 2013 Nov;57(9):1246-52
pubmed: 23946222
Spinal Cord. 2017 Jul;55(7):687-691
pubmed: 28169292
MMWR Morb Mortal Wkly Rep. 2013 Mar 8;62(9):165-70
pubmed: 23466435
Am J Infect Control. 2015 Oct 1;43(10):1076-80
pubmed: 26190386
Antimicrob Agents Chemother. 2017 Dec 21;62(1):
pubmed: 29038269
Am J Infect Control. 2017 Nov 1;45(11):1183-1189
pubmed: 28757086
Ann Clin Microbiol Antimicrob. 2017 Mar 29;16(1):18
pubmed: 28356109
Infect Control Hosp Epidemiol. 2017 Dec;38(12):1464-1471
pubmed: 29157323
Infect Control Hosp Epidemiol. 2016 Nov;37(11):1288-1301
pubmed: 27573805
JAMA. 2015 Oct 13;314(14):1479-87
pubmed: 26436831
Infect Control Hosp Epidemiol. 2016 Jul;37(7):768-76
pubmed: 27025908
Spinal Cord. 2016 Nov;54(11):1001-1009
pubmed: 27001131
J Spinal Cord Med. 2018 Mar;41(2):199-207
pubmed: 28198662