It appears you don't have support to open PDFs in this web browser. To view this file, Open with your PDF reader
Abstract
Background
The CRE epidemic in Colombia is amplified by horizontal transmission of mobile genetic elements encoding KPC among Enterobacteriaeae and clonal expansion of K. pneumoniae clonal group (CG) 258, making the country hyperendemic for CRE. However, the clinical impact of CRE infections has not been comprehensively assessed.
Methods
In the framework of a prospective study assessing the clinical epidemiology of CRE (CRACKLE II), we report the results of the first 246 patients enrolled in 5 Colombian hospitals (from July 2017 to November 2018). Clinical variables, outcomes at 90 days post-hospitalization and susceptibility patterns were collected. Resistance to carbapenems was defined per CDC guidelines. Infection was defined with standardized criteria. All isolates which did not meet these criteria were considered colonization
Results
The majority of patients were men (66%); median age was 62 years [IQR 37–73]); 67% were admitted from home and 33% were hospital transfers. The mean Charlson Comorbidity Index and Pitt Bacteremia scores were 2 (SD = 2) and 3 (SD = 3), respectively. Most patients (60%; n = 148) were considered to be infected. The most frequent source of culture was urine (36%), followed by blood (30%) and wound secretions (13%). A respiratory source was found in the minority (6%) of patients. Species of CRE are summarized in Table 1 with the majority being K. pneumoniae. The best in vitro activity against CRE was found for fosfomycin (80% susceptible (47/59)), tigecycline (75% (67/89)), colistin (70% (35/50)) and amikacin (67% (148/220)). From 234 patients with available information at 90 days of follow-up, 13% were readmitted after discharge. Mortality at 30 and 90 days after a positive culture was 31% and 35%, respectively.
Conclusion
K. pneumoniae are the main drivers of the CRE epidemic in Colombia isolated mainly from non-respiratory sources. Non-susceptibility to last resource antibiotics (tigecycline, colistin and fosfomycin) is substantial among the Colombian isolates leaving few therapeutic options, a finding that correlates with high mortality. Our findings indicate that introduction of novel therapeutics in Colombia is urgently needed with a rampant epidemic of CRE causing high burden of disease.
Disclosures
All authors: No reported disclosures.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
Details
1 Hospital Universitario San Ignacio - Pontificia Universidad Javeriana, Bogota, Distrito Capital de Bogota, Colombia
2 George Washington University, Rockville, Maryland
3 Clínica General del Norte. Universidad Simón Bolívar, Barranquilla, Atlantico, Colombia
4 Clinica General del Norte, Barranquilla, Atlantico, Colombia
5 Grupo de Investigación Hospital Universitario San Jorge, Pereira, Risaralda, Colombia
6 Hospital Universitario San Ignacio, Bogota, Distrito Capital de Bogota, Colombia
7 Centro Medico Imbanaco, Cali, Valle del Cauca, Colombia
8 Centro Médico Imbanaco de Cali, Bogotá, Distrito Capital de Bogota, Colombia
9 Hospital Universitario Erasmo Meoz, Cucuta, Norte de Santander, Colombia
10 Molecular Genetics and Antimicrobial Resistance Unit and International Center for Microbial Genomics, Universidad El Bosque, Bogota, Distrito Capital de Bogota, Colombia
11 Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Distrito Capital de Bogota, Colombia
12 Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria - RAEH, Universidad El Bosque, Cali, Valle del Cauca, Colombia
13 UC San Francisco School of Medicine, San Francisco, California
14 Duke University Medical Center, Durham, North Carolina
15 The George Washington University, Rockville, Maryland
16 Hackensack Meridian Health, Hackensack, New Jersey
17 Universidad El Bosque, Bogota, Distrito Capital de Bogota, Colombia
18 Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
19 UNC School of Medicine, Chapel Hill, North Carolina
20 CARMiG, UTHealth and Center for Infectious Diseases, UTHealth School of Public Health, Houston, Texas; Molecular Genetics and Antimicrobial Resistance Unit and International Center for Microbial Genomics, Universidad El Bosque, BOG, COL, Houston, Texas