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The Complex Epidemiology of Carbapenem-Resistant Enterobacter Infections: A Multicenter Descriptive Analysis

Published online by Cambridge University Press:  24 September 2015

Tsilia Lazarovitch ,
Keren Amity ,
Joseph R. Coyle ,
Benjamin Ackerman ,
Ruthy Tal-Jasper ,
Hadas Ofer-Friedman ,
Kayoko Hayakawa ,
Christopher Bogan ,
Paul R. Lephart  and
Tamir Kaplansky
...Show all authors
Tsilia Lazarovitch
Affiliation:
Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel
Keren Amity
Affiliation:
Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel
Joseph R. Coyle
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Benjamin Ackerman
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Ruthy Tal-Jasper
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Hadas Ofer-Friedman
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Christopher Bogan
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Paul R. Lephart
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Tamir Kaplansky
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Moran Maskit
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Tal Azouri
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Ronit Zaidenstein
Affiliation:
Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Federico Perez
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Veterans Integrated Service Networks (VISN)-10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio.
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Dror Marchaim*
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Address correspondence to Dror Marchaim, MD, Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, 70300, Israel (drormarchaim@gmail.com).
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Abstract

BACKGROUND

The pandemic of carbapenem-resistant Enterobacteriaceae (CRE) was primarily due to clonal spread of blaKPC producing Klebsiella pneumoniae. Thus, thoroughly studied CRE cohorts have consisted mostly of K. pneumoniae.

OBJECTIVE

To conduct an extensive epidemiologic analysis of carbapenem-resistant Enterobacter spp. (CREn) from 2 endemic and geographically distinct centers.

METHODS

CREn were investigated at an Israeli center (Assaf Harofeh Medical Center, January 2007 to July 2012) and at a US center (Detroit Medical Center, September 2008 to September 2009). blaKPC genes were queried by polymerase chain reaction. Repetitive extragenic palindromic polymerase chain reaction and pulsed-field gel electrophoresis were used to determine genetic relatedness.

RESULTS

In this analysis, 68 unique patients with CREn were enrolled. Sixteen isolates (24%) were from wounds, and 33 (48%) represented colonization only. All isolates exhibited a positive Modified Hodge Test, but only 93% (27 of 29) contained blaKPC. Forty-three isolates (63%) were from elderly adults, and 5 (7.4%) were from neonates. Twenty-seven patients died in hospital (40.3% of infected patients). Enterobacter strains consisted of 4 separate clones from Assaf Harofeh Medical Center and of 4 distinct clones from Detroit Medical Center.

CONCLUSIONS

In this study conducted at 2 distinct CRE endemic regions, there were unique epidemiologic features to CREn: (i) polyclonality, (ii) neonates accounting for more than 7% of cohort, and (iii) high rate of colonization (almost one-half of all cases represented colonization). Since false-positive Modified Hodge Tests in Enterobacter spp. are common, close monitoring of carbapenem resistance mechanisms (particularly carbapenemase production) among Enterobacter spp. is important.

Infect. Control Hosp. Epidemiol. 2015;36(11):1283–1291

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1283 - 1291
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

T. L. and K. A. contributed equally to this article.

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