The Experts below are selected from a list of 17550 Experts worldwide ranked by ideXlab platform
Brandi Limbago - One of the best experts on this subject based on the ideXlab platform.
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the problem of carbapenemase producing carbapenem resistant Enterobacteriaceae detection
Journal of Clinical Microbiology, 2016Co-Authors: Joseph D. Lutgring, Brandi LimbagoAbstract:The emergence and spread of carbapenemase-producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) are a significant clinical and public health concern. Reliable detection of CP-CRE is the first step in combating this problem. There are both phenotypic and molecular methods available for CP-CRE detection. There is no single detection method that is ideal for all situations.
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Thirty-day laboratory-based surveillance for Carbapenem-Resistant Enterobacteriaceae in the Minneapolis-St. Paul metropolitan area.
Infection Control and Hospital Epidemiology, 2014Co-Authors: Edwin C. Pereira, Alexander J Kallen, Brandi Limbago, Kristin M. Shaw, Paula Snippes Vagnone, Jane Harper, Ruth LynfieldAbstract:Carbapenem-Resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time.
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Epidemiology and prevention of Carbapenem-Resistant Enterobacteriaceae in the United States.
Expert Review of Anti-infective Therapy, 2014Co-Authors: Alice Guh, Brandi Limbago, Alexander J KallenAbstract:Carbapenem-Resistant Enterobacteriaceae (CRE) are multidrug-resistant organisms with few treatment options that cause infections associated with substantial morbidity and mortality. CRE outbreaks have been increasingly reported worldwide and are mainly due to the emergence and spread of strains that produce carbapenemases. In the United States, transmission of CRE is primarily driven by the spread of organisms carrying the Klebsiella pneumoniae carbapenemase enzyme, but other carbapenemase enzymes, such as the New-Delhi metallo-β-lactamase, have also emerged. Currently recommended control strategies for healthcare facilities include the detection of patients infected or colonized with CRE and implementation of measures to prevent further spread. In addition to efforts in individual facilities, effective CRE control requires coordination across all healthcare facilities in a region. This review describes the current epidemiology and surveillance of CRE in the United States and the recommended approach to p...
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carbapenem resistant Enterobacteriaceae epidemiology and prevention
Clinical Infectious Diseases, 2011Co-Authors: Neil Gupta, Brandi Limbago, Jean B Patel, Alexander J KallenAbstract:Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States. Infections caused by CRE have limited treatment options and have been associated with high mortality rates. In the previous year, other carbapenemase subtypes, including New Delhi metallo-β-lactamase, have been identified among Enterobacteriaceae in the United States. Like KPC, these enzymes are frequently found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE transmission and CRE infections have become important public health objectives. This review describes the current epidemiology of CRE in the United States and highlights important prevention strategies.
Dror Marchaim - One of the best experts on this subject based on the ideXlab platform.
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Screening for Carbapenem-Resistant Enterobacteriaceae: Who, When, and How?
Virulence, 2016Co-Authors: Sandra S. Richter, Dror MarchaimAbstract:The global spread of Carbapenem-Resistant Enterobacteriaceae (CRE) has been fostered by the lack of preemptive screening of patients in healthcare facilities that could prevent patient-to-patient transmission. Outbreaks of CRE infections have led some institutions to implement rigorous screening programs, although controlled comparative data are frequently lacking. Resource limitations and uncertainty regarding the optimal approach has kept many facilities from enacting more active routine surveillance policies that could reduce the prevalence of CRE. The ideal population to target for screening, the frequency of testing, and the preferred test method are components of surveillance programs that remain open to debate. This review discusses the rationale for different screening policies in use and the performance characteristics of laboratory methods available to detect CRE carriage.
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Fosfomycin activity versus Carbapenem-Resistant Enterobacteriaceae and vancomycin-resistant Enterococcus, Detroit, 2008-10.
The Journal of Antibiotics, 2013Co-Authors: Jason M Pogue, Suchitha Bheemreddy, Emily T. Martin, Odaliz Abreu-lanfranco, Kayoko Hayakawa, Dror Marchaim, Bharath Sunkara, Ryan P Mynatt, Jing J. Zhao, Sorabh DharAbstract:Fosfomycin activity versus Carbapenem-Resistant Enterobacteriaceae and vancomycin-resistant Enterococcus , Detroit, 2008–10
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The Carbapenem-Resistant Enterobacteriaceae score: A bedside score to rule out infection with Carbapenem-Resistant Enterobacteriaceae among hospitalized patients
American Journal of Infection Control, 2012Co-Authors: Emily T. Martin, Teena Chopra, Jason M Pogue, Ryan Tansek, Vicki L. Collins, Odaliz Abreu-lanfranco, Paul R. Lephart, Keith S. Kaye, Kayoko Hayakawa, Dror MarchaimAbstract:Patients infected with Carbapenem-Resistant Enterobacteriaceae often experience delays in initiation of appropriate antimicrobial therapy and increased mortality. A score was developed to differentiate bloodstream infections caused by Carbapenem-Resistant Enterobacteriaceae (16 patients) versus extended-spectrum β-lactamase-producing Enterobacteriaceae (166 patients). A score of ≥32 demonstrated high area under the curve of 0.80 (95% confidence interval: 0.68-0.92) and a negative predictive value of 97%.
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recent exposure to antimicrobials and carbapenem resistant Enterobacteriaceae the role of antimicrobial stewardship
Infection Control and Hospital Epidemiology, 2012Co-Authors: Dror Marchaim, Teena Chopra, Ashish Bhargava, Sorabh Dhar, Jason M Pogue, Suchitha Bheemreddy, Christopher Blunden, Christopher Bogan, Kayoko Hayakawa, Maryann ShangoAbstract:background. Carbapenem-Resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures. To identify specific predictors of CRE, patients with CRE were compared with 3 control groups: (1) patients with extendedspectrum b-lactamase (ESBL)‐producing Enterobacteriaceae, (2) patients with non-ESBL-containing Enterobacteriaceae, and (3) uninfected controls.
Neil Woodford - One of the best experts on this subject based on the ideXlab platform.
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In Vitro Activity of Eravacycline against Carbapenem-Resistant Enterobacteriaceae and Acinetobacter baumannii
Antimicrobial Agents and Chemotherapy, 2016Co-Authors: David M. Livermore, Marina Warner, Shazad Mushtaq, Neil WoodfordAbstract:Eravacycline and comparators were tested against carbapenem- and tigecycline-resistant Enterobacteriaceae and Acinetobacter isolates received at the United Kingdom's national reference laboratory. Eravacycline MICs correlated closely with those of tigecycline but mostly were around 2-fold lower; both molecules retained full activity against isolates with high-level tetracycline and minocycline resistance. MIC90s of eravacycline and tigecycline were raised ca. 2-fold for Carbapenem-Resistant Enterobacteriaceae compared with carbapenem-susceptible controls, probably reflecting subsets of isolates with increased efflux.
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Emergence of Carbapenem-Resistant Enterobacteriaceae in a UK paediatric hospital
Journal of Hospital Infection, 2013Co-Authors: Richard J. Drew, Jane F. Turton, Robert Hill, David M. Livermore, Neil Woodford, Stéphane Paulus, Nigel A. CunliffeAbstract:Summary Background Carbapenem-Resistant Enterobacteriaceae are an emerging global infection threat. However, there are few data describing their clinical importance in children. Aim This retrospective study reviewed the prevalence and resistance mechanisms of Carbapenem-Resistant Enterobacteriaceae grown from clinical and surveillance samples in a large tertiary referral children's hospital in the UK. Methods Carbapenem-Resistant Enterobacteriaceae were sought in specimens submitted for diagnostic and surveillance purposes at Alder Hey Children's NHS Foundation Trust, Liverpool, between September 2011 and August 2012. Mechanisms of resistance were identified using phenotypic and/or molecular methods. Variable number tandem repeat profiling was used to type carbapenemase-producing strains. Findings During the 12-month study period, Carbapenem-Resistant Enterobacteriaceae were recovered from 24 patients. Five isolates were from clinical diagnostic specimens whereas 19 of 421 patients had positive rectal surveillance swabs (4.5%). Of the 24 isolates, seven (all Klebsiella spp.) harboured carbapenemases: three had bla KPC and four bla NDM , whereas 17 had resistance due to combinations of AmpC or extended-spectrum β-lactamase activity plus impermeability. Conclusion Carbapenem-Resistant Enterobacteriaceae and, in particular, those with carbapenemases, are an emerging infection problem in a major paediatric hospital in the UK. Active surveillance is required to monitor and control their spread.
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activity of bal30072 alone or combined with β lactamase inhibitors or with meropenem against carbapenem resistant Enterobacteriaceae and non fermenters
Journal of Antimicrobial Chemotherapy, 2013Co-Authors: Shazad Mushtaq, Neil Woodford, Russell Hope, Rachael Adkin, David M. LivermoreAbstract:Objectives We investigated the activity of BAL30072, a dihydroxypyridone monosulfactam, against Carbapenem-Resistant Enterobacteriaceae and non-fermenters (i) alone, (ii) combined with BAL29880 (to inhibit AmpC) and/or clavulanate [to inhibit extended-spectrum s-lactamases (ESBLs)] and (iii) combined 1?:?1 with meropenem. Methods Isolates were from multiple UK hospitals. MICs were determined by CLSI agar dilution. Carbapenemases were identified by PCR and sequencing. Results BAL30072 inhibited 69% of the Carbapenem-Resistant Enterobacteriaceae at =4 mg/L, including 60%–87% with OXA-48, IMP, NDM and VIM enzymes or combinations of impermeability with AmpC or ESBL, and 40% with KPC enzymes. The proportions susceptible exceeded 90% for BAL30072?+?BAL29880?+?clavulanate, except for isolates with KPC carbapenemases, where members of the international sequence type (ST) 258 Klebsiella pneumoniae clone remained resistant. At 4 mg/L, BAL30072 was active against all OprD-deficient Pseudomonas aeruginosa, against 8/12 with efflux-type s-lactam resistance and 19/25 with metallo-carbapenemases; these proportions were little increased if inhibitors were added. Most Acinetobacter baumannii with OXA or NDM carbapenemases were susceptible to BAL30072 alone at =4 mg/L, but those with OXA-58 were resistant, probably for reasons other than their s-lactamase. Addition of meropenem to BAL30072 increased activity against some individual isolates, but with little clear relationship to the resistance mechanism, except for consistent potentiation against OprD-deficient P. aeruginosa. Conclusions BAL30072 had good activity against many diverse carbapenem resistance types. Adding clavulanate and/or BAL29880 extended activity against Carbapenem-Resistant Enterobacteriaceae, but not non-fermenters. Adding meropenem resulted in small increases in activity against individual isolates. Resistance remained common in the K. pneumoniae ST258 KPC clone, even with both inhibitors or meropenem added.
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What remains against Carbapenem-Resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline
International Journal of Antimicrobial Agents, 2011Co-Authors: David M. Livermore, Marina Warner, Shazad Mushtaq, Michel Doumith, Jiancheng Zhang, Neil WoodfordAbstract:Carbapenem-Resistant Enterobacteriaceae present an increasing and diverse problem, including strains of multiple species with metallo-β-lactamases (IMP, NDM or VIM) and non-metallo KPC and OXA-48 enzymes as well as those combining an extended-spectrum β-lactamase (ESBL) or AmpC enzyme with porin loss. Most strains, except those with OXA-48 alone, are broadly resistant to β-lactams and have multiple aminoglycoside-modifying enzymes; those with NDM-1 carbapenemase typically also have 16S rRNA methylases, conferring complete aminoglycoside resistance. In this study, the activity of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline was evaluated against 81 Carbapenem-Resistant Enterobacteriaceae isolates from the UK. Testing was performed by the Clinical and Laboratory Standards Institute (CLSI) agar dilution method. Chloramphenicol, ciprofloxacin and nitrofurantoin inhibited
David M. Livermore - One of the best experts on this subject based on the ideXlab platform.
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In Vitro Activity of Eravacycline against Carbapenem-Resistant Enterobacteriaceae and Acinetobacter baumannii
Antimicrobial Agents and Chemotherapy, 2016Co-Authors: David M. Livermore, Marina Warner, Shazad Mushtaq, Neil WoodfordAbstract:Eravacycline and comparators were tested against carbapenem- and tigecycline-resistant Enterobacteriaceae and Acinetobacter isolates received at the United Kingdom's national reference laboratory. Eravacycline MICs correlated closely with those of tigecycline but mostly were around 2-fold lower; both molecules retained full activity against isolates with high-level tetracycline and minocycline resistance. MIC90s of eravacycline and tigecycline were raised ca. 2-fold for Carbapenem-Resistant Enterobacteriaceae compared with carbapenem-susceptible controls, probably reflecting subsets of isolates with increased efflux.
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Emergence of Carbapenem-Resistant Enterobacteriaceae in a UK paediatric hospital
Journal of Hospital Infection, 2013Co-Authors: Richard J. Drew, Jane F. Turton, Robert Hill, David M. Livermore, Neil Woodford, Stéphane Paulus, Nigel A. CunliffeAbstract:Summary Background Carbapenem-Resistant Enterobacteriaceae are an emerging global infection threat. However, there are few data describing their clinical importance in children. Aim This retrospective study reviewed the prevalence and resistance mechanisms of Carbapenem-Resistant Enterobacteriaceae grown from clinical and surveillance samples in a large tertiary referral children's hospital in the UK. Methods Carbapenem-Resistant Enterobacteriaceae were sought in specimens submitted for diagnostic and surveillance purposes at Alder Hey Children's NHS Foundation Trust, Liverpool, between September 2011 and August 2012. Mechanisms of resistance were identified using phenotypic and/or molecular methods. Variable number tandem repeat profiling was used to type carbapenemase-producing strains. Findings During the 12-month study period, Carbapenem-Resistant Enterobacteriaceae were recovered from 24 patients. Five isolates were from clinical diagnostic specimens whereas 19 of 421 patients had positive rectal surveillance swabs (4.5%). Of the 24 isolates, seven (all Klebsiella spp.) harboured carbapenemases: three had bla KPC and four bla NDM , whereas 17 had resistance due to combinations of AmpC or extended-spectrum β-lactamase activity plus impermeability. Conclusion Carbapenem-Resistant Enterobacteriaceae and, in particular, those with carbapenemases, are an emerging infection problem in a major paediatric hospital in the UK. Active surveillance is required to monitor and control their spread.
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activity of bal30072 alone or combined with β lactamase inhibitors or with meropenem against carbapenem resistant Enterobacteriaceae and non fermenters
Journal of Antimicrobial Chemotherapy, 2013Co-Authors: Shazad Mushtaq, Neil Woodford, Russell Hope, Rachael Adkin, David M. LivermoreAbstract:Objectives We investigated the activity of BAL30072, a dihydroxypyridone monosulfactam, against Carbapenem-Resistant Enterobacteriaceae and non-fermenters (i) alone, (ii) combined with BAL29880 (to inhibit AmpC) and/or clavulanate [to inhibit extended-spectrum s-lactamases (ESBLs)] and (iii) combined 1?:?1 with meropenem. Methods Isolates were from multiple UK hospitals. MICs were determined by CLSI agar dilution. Carbapenemases were identified by PCR and sequencing. Results BAL30072 inhibited 69% of the Carbapenem-Resistant Enterobacteriaceae at =4 mg/L, including 60%–87% with OXA-48, IMP, NDM and VIM enzymes or combinations of impermeability with AmpC or ESBL, and 40% with KPC enzymes. The proportions susceptible exceeded 90% for BAL30072?+?BAL29880?+?clavulanate, except for isolates with KPC carbapenemases, where members of the international sequence type (ST) 258 Klebsiella pneumoniae clone remained resistant. At 4 mg/L, BAL30072 was active against all OprD-deficient Pseudomonas aeruginosa, against 8/12 with efflux-type s-lactam resistance and 19/25 with metallo-carbapenemases; these proportions were little increased if inhibitors were added. Most Acinetobacter baumannii with OXA or NDM carbapenemases were susceptible to BAL30072 alone at =4 mg/L, but those with OXA-58 were resistant, probably for reasons other than their s-lactamase. Addition of meropenem to BAL30072 increased activity against some individual isolates, but with little clear relationship to the resistance mechanism, except for consistent potentiation against OprD-deficient P. aeruginosa. Conclusions BAL30072 had good activity against many diverse carbapenem resistance types. Adding clavulanate and/or BAL29880 extended activity against Carbapenem-Resistant Enterobacteriaceae, but not non-fermenters. Adding meropenem resulted in small increases in activity against individual isolates. Resistance remained common in the K. pneumoniae ST258 KPC clone, even with both inhibitors or meropenem added.
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What remains against Carbapenem-Resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline
International Journal of Antimicrobial Agents, 2011Co-Authors: David M. Livermore, Marina Warner, Shazad Mushtaq, Michel Doumith, Jiancheng Zhang, Neil WoodfordAbstract:Carbapenem-Resistant Enterobacteriaceae present an increasing and diverse problem, including strains of multiple species with metallo-β-lactamases (IMP, NDM or VIM) and non-metallo KPC and OXA-48 enzymes as well as those combining an extended-spectrum β-lactamase (ESBL) or AmpC enzyme with porin loss. Most strains, except those with OXA-48 alone, are broadly resistant to β-lactams and have multiple aminoglycoside-modifying enzymes; those with NDM-1 carbapenemase typically also have 16S rRNA methylases, conferring complete aminoglycoside resistance. In this study, the activity of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline was evaluated against 81 Carbapenem-Resistant Enterobacteriaceae isolates from the UK. Testing was performed by the Clinical and Laboratory Standards Institute (CLSI) agar dilution method. Chloramphenicol, ciprofloxacin and nitrofurantoin inhibited
Alexander J Kallen - One of the best experts on this subject based on the ideXlab platform.
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Thirty-day laboratory-based surveillance for Carbapenem-Resistant Enterobacteriaceae in the Minneapolis-St. Paul metropolitan area.
Infection Control and Hospital Epidemiology, 2014Co-Authors: Edwin C. Pereira, Alexander J Kallen, Brandi Limbago, Kristin M. Shaw, Paula Snippes Vagnone, Jane Harper, Ruth LynfieldAbstract:Carbapenem-Resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time.
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Epidemiology and prevention of Carbapenem-Resistant Enterobacteriaceae in the United States.
Expert Review of Anti-infective Therapy, 2014Co-Authors: Alice Guh, Brandi Limbago, Alexander J KallenAbstract:Carbapenem-Resistant Enterobacteriaceae (CRE) are multidrug-resistant organisms with few treatment options that cause infections associated with substantial morbidity and mortality. CRE outbreaks have been increasingly reported worldwide and are mainly due to the emergence and spread of strains that produce carbapenemases. In the United States, transmission of CRE is primarily driven by the spread of organisms carrying the Klebsiella pneumoniae carbapenemase enzyme, but other carbapenemase enzymes, such as the New-Delhi metallo-β-lactamase, have also emerged. Currently recommended control strategies for healthcare facilities include the detection of patients infected or colonized with CRE and implementation of measures to prevent further spread. In addition to efforts in individual facilities, effective CRE control requires coordination across all healthcare facilities in a region. This review describes the current epidemiology and surveillance of CRE in the United States and the recommended approach to p...
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vital signs carbapenem resistant Enterobacteriaceae
Morbidity and Mortality Weekly Report, 2013Co-Authors: Jesse T Jacob, Eili Y Klein, Zintars G Beldavs, Ruth Lynfield, Alexander J Kallen, Philip Ricks, Arjun Srinivasan, Ramanan Laxminarayan, Jonathan R. Edwards, Scott K FridkinAbstract:Background Enterobacteriaceae are a family of bacteria that commonly cause infections in health-care settings as well as in the community. Among Enterobacteriaceae, resistance to broad-spectrum carbapenem antimicrobials has been uncommon. Over the past decade, however, Carbapenem-Resistant Enterobacteriaceae (CRE) have been recognized in health-care settings as a cause of difficult-to-treat infections associated with high mortality.
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carbapenem resistant Enterobacteriaceae epidemiology and prevention
Clinical Infectious Diseases, 2011Co-Authors: Neil Gupta, Brandi Limbago, Jean B Patel, Alexander J KallenAbstract:Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States. Infections caused by CRE have limited treatment options and have been associated with high mortality rates. In the previous year, other carbapenemase subtypes, including New Delhi metallo-β-lactamase, have been identified among Enterobacteriaceae in the United States. Like KPC, these enzymes are frequently found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE transmission and CRE infections have become important public health objectives. This review describes the current epidemiology of CRE in the United States and highlights important prevention strategies.