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2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections

BACKGROUND: CREs are feared pathogens with resistance occurring through the production of carbapenemases. Identification of carbapenemase-producing (CP) organisms assists with proper antimicrobial selection of commonly used agents, such as ceftazidime/avibactam (CA), meropenem/vaborbactam (MV), and...

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Autores principales: Minor, Sarah Brooks, Alexander, Jose
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810656/
http://dx.doi.org/10.1093/ofid/ofz360.1810
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author Minor, Sarah Brooks
Alexander, Jose
author_facet Minor, Sarah Brooks
Alexander, Jose
author_sort Minor, Sarah Brooks
collection PubMed
description BACKGROUND: CREs are feared pathogens with resistance occurring through the production of carbapenemases. Identification of carbapenemase-producing (CP) organisms assists with proper antimicrobial selection of commonly used agents, such as ceftazidime/avibactam (CA), meropenem/vaborbactam (MV), and tigecycline (TG). AdventHealth Orlando implemented a CRE screening method based on meropenem (MER) and a confirmatory CRE PCR testing in March 2018. Prior to implementing this test, patients were deemed to have CRE infections (CREI) if the organism demonstrated resistance to any carbapenem. The objective of this study was to evaluate the impact of this testing on the utilization of anti-CRE antibiotics. METHODS: This was a retrospective pre (March 2017–February 2018)- and post (March 2018–February 2019)-implementation study examining the impact of CRE PCR testing. Outcomes included the number of antibiotic days saved, average duration of therapy (DOT), median length of stay (LOS), and change in CP-CRE prevalence. The intervention consisted of the implementation of CRE PCR testing and included inpatients > 18 years old who received either CA, MV, or TG for the treatment of a CREI. RESULTS: Post-implementation, 30 unique patients were identified as having a positive K. pneumoniae carbapenemase gene by PCR, indicating a CP-CRE and received CA, MV, or TG; whereas, 42 patients in the pre-implementation group had a CREI and received CA, MV, or TG. Testing to identify CP-CREs led to a 50% reduction in the number of antibiotic days for CA, MV, and TG (575 vs. 287 days, P < 0.0001). Additionally, the average DOT decreased by 2.5 days in the post-implementation group (10.5 days vs. 8 days, P = 0.18) along with a 3.5-day shorter median LOS (15 days vs. 11.5 days, P = 0.48). The CRE prevalence based on resistance only to MER is 0.27%, compared with the previously reported rate of 2.5% that included resistance to ertapenem or MER. CONCLUSION: Implementing CRE PCR testing to identify CP-CRE organisms resulted in a significant reduction in utilization of anti-CRE agents for CREIs. Additionally, the testing algorithm allowed for accurate reporting of our local CRE prevalence. By avoiding CA, MV, or TG in patients without CP-CREs, this has the potential to optimize therapy while reducing collateral damage associated with broad-spectrum agents. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68106562019-10-28 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections Minor, Sarah Brooks Alexander, Jose Open Forum Infect Dis Abstracts BACKGROUND: CREs are feared pathogens with resistance occurring through the production of carbapenemases. Identification of carbapenemase-producing (CP) organisms assists with proper antimicrobial selection of commonly used agents, such as ceftazidime/avibactam (CA), meropenem/vaborbactam (MV), and tigecycline (TG). AdventHealth Orlando implemented a CRE screening method based on meropenem (MER) and a confirmatory CRE PCR testing in March 2018. Prior to implementing this test, patients were deemed to have CRE infections (CREI) if the organism demonstrated resistance to any carbapenem. The objective of this study was to evaluate the impact of this testing on the utilization of anti-CRE antibiotics. METHODS: This was a retrospective pre (March 2017–February 2018)- and post (March 2018–February 2019)-implementation study examining the impact of CRE PCR testing. Outcomes included the number of antibiotic days saved, average duration of therapy (DOT), median length of stay (LOS), and change in CP-CRE prevalence. The intervention consisted of the implementation of CRE PCR testing and included inpatients > 18 years old who received either CA, MV, or TG for the treatment of a CREI. RESULTS: Post-implementation, 30 unique patients were identified as having a positive K. pneumoniae carbapenemase gene by PCR, indicating a CP-CRE and received CA, MV, or TG; whereas, 42 patients in the pre-implementation group had a CREI and received CA, MV, or TG. Testing to identify CP-CREs led to a 50% reduction in the number of antibiotic days for CA, MV, and TG (575 vs. 287 days, P < 0.0001). Additionally, the average DOT decreased by 2.5 days in the post-implementation group (10.5 days vs. 8 days, P = 0.18) along with a 3.5-day shorter median LOS (15 days vs. 11.5 days, P = 0.48). The CRE prevalence based on resistance only to MER is 0.27%, compared with the previously reported rate of 2.5% that included resistance to ertapenem or MER. CONCLUSION: Implementing CRE PCR testing to identify CP-CRE organisms resulted in a significant reduction in utilization of anti-CRE agents for CREIs. Additionally, the testing algorithm allowed for accurate reporting of our local CRE prevalence. By avoiding CA, MV, or TG in patients without CP-CREs, this has the potential to optimize therapy while reducing collateral damage associated with broad-spectrum agents. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810656/ http://dx.doi.org/10.1093/ofid/ofz360.1810 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Minor, Sarah Brooks
Alexander, Jose
2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title_full 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title_fullStr 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title_full_unstemmed 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title_short 2130. Detection of Carbapenemase-Producing Organisms and Impact on Antimicrobial Utilization for Carbapenem-Resistant Enterobacteriaceae (CRE) Infections
title_sort 2130. detection of carbapenemase-producing organisms and impact on antimicrobial utilization for carbapenem-resistant enterobacteriaceae (cre) infections
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810656/
http://dx.doi.org/10.1093/ofid/ofz360.1810
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