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Evaluation of Discrepancies in Carbapenem Minimum Inhibitory Concentrations Obtained at Clinical Laboratories Compared to a Public Health Laboratory
- Julian E. Grass, Shelley S. Magill, Isaac See, Uzma Ansari, Lucy E. Wilson, Elisabeth Vaeth, Paula Snippes Vagnone, Brittany Pattee, Jesse T. Jacob, Georgia Emerging Infections Program, Chris Bower, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Sarah W. Satola, Sarah J. Janelle, Kyle Schutz, Rebecca Tsay, Marion A. Kainer, Daniel Muleta, P. Maureen Cassidy, Vivian H. Leung, Meghan Maloney, Erin C. Phipps, New Mexico Emerging Infections Program, Kristina G. Flores, New Mexico Emerging Infections Program, Erin Epson, Joelle Nadle, Maria Karlsson, Joseph D. Lutgring
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s474-s476
- Print publication:
- October 2020
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- Article
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Background: Automated testing instruments (ATIs) are commonly used by clinical microbiology laboratories to perform antimicrobial susceptibility testing (AST), whereas public health laboratories may use established reference methods such as broth microdilution (BMD). We investigated discrepancies in carbapenem minimum inhibitory concentrations (MICs) among Enterobacteriaceae tested by clinical laboratory ATIs and by reference BMD at the CDC. Methods: During 2016–2018, we conducted laboratory- and population-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE) through the CDC Emerging Infections Program (EIP) sites (10 sites by 2018). We defined an incident case as the first isolation of Enterobacter spp (E. cloacae complex or E. aerogenes), Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or K. variicola resistant to doripenem, ertapenem, imipenem, or meropenem from normally sterile sites or urine identified from a resident of the EIP catchment area in a 30-day period. Cases had isolates that were determined to be carbapenem-resistant by clinical laboratory ATI MICs (MicroScan, BD Phoenix, or VITEK 2) or by other methods, using current Clinical and Laboratory Standards Institute (CLSI) criteria. A convenience sample of these isolates was tested by reference BMD at the CDC according to CLSI guidelines. Results: Overall, 1,787 isolates from 112 clinical laboratories were tested by BMD at the CDC. Of these, clinical laboratory ATI MIC results were available for 1,638 (91.7%); 855 (52.2%) from 71 clinical laboratories did not confirm as CRE at the CDC. Nonconfirming isolates were tested on either a MicroScan (235 of 462; 50.9%), BD Phoenix (249 of 411; 60.6%), or VITEK 2 (371 of 765; 48.5%). Lack of confirmation was most common among E. coli (62.2% of E. coli isolates tested) and Enterobacter spp (61.4% of Enterobacter isolates tested) (Fig. 1A), and among isolates testing resistant to ertapenem by the clinical laboratory ATI (52.1%, Fig. 1B). Of the 1,388 isolates resistant to ertapenem in the clinical laboratory, 1,006 (72.5%) were resistant only to ertapenem. Of the 855 nonconfirming isolates, 638 (74.6%) were resistant only to ertapenem based on clinical laboratory ATI MICs. Conclusions: Nonconfirming isolates were widespread across laboratories and ATIs. Lack of confirmation was most common among E. coli and Enterobacter spp. Among nonconfirming isolates, most were resistant only to ertapenem. These findings may suggest that ATIs overcall resistance to ertapenem or that isolate transport and storage conditions affect ertapenem resistance. Further investigation into this lack of confirmation is needed, and CRE case identification in public health surveillance may need to account for this phenomenon.
Funding: None
Disclosures: None
11 - Eichhornia crassipes (Mart.) Solms–Laub. (Pontederiaceae)
- Edited by Rangaswamy Muniappan, Virginia Polytechnic Institute and State University, Gadi V. P. Reddy, University of Guam, Anantanarayanan Raman, Charles Sturt University, Orange, New South Wales
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- Book:
- Biological Control of Tropical Weeds Using Arthropods
- Published online:
- 04 August 2010
- Print publication:
- 05 March 2009, pp 183-210
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Summary
Introduction
Eichhornia crassipes (Mart.) Solms-Laub. (water hyacinth; Pontederiaceae), an erect free-floating herbaceous plant, is indigenous to tropical South America (Gopal, 1987), but has been spread throughout the world. In the absence of its original suite of natural enemies, and usually in nutrient-enriched waters, it quickly becomes invasive, and is now the most important aquatic weed worldwide (Center, 1994; Julien et al., 1996). It colonizes still or slow moving waters, resulting in thick extensive mats, which impede water traffic, reduce water quality (Edwards and Musil, 1975), and alter social structures for human riparian communities, such as those living on the Sepik River of Papua New Guinea. Infestations continue to plague freshwater bodies, particularly in tropical Africa (Navarro and Phiri, 2000), India (Kathiresan, 2000), and China (Ding et al., 2001), causing significant environmental, economic and social problems, particularly for communities reliant on water bodies for sustenance and survival (Fig. 11.1).
Taxonomy
Eichhornia crassipes is in the Pontederiaceae, a taxonomically problematic family, which has recently been included in the Commelinales (APG II, 2003; Strange et al., 2004). Eight other genera occur in this family of predominantly neotropical, freshwater aquatics, and eight species in the genus Eichhornia (Cook, 1998), all of which originated in South America, except E. natans (P. Beauv.) which is native to tropical Africa (Gopal, 1987). Only E. crassipes is regarded as a pantropical aquatic weed. The common names of E. crassipes are “water hyacinth”, ‘waterhyacinth’ or “water-hyacinth.”