1. Prevalence of carbapenem resistance and carbapenemase production among Enterobacteriaceae isolated from urine in the UK: results of the UK infection-Carbapenem Resistance Evaluation Surveillance Trial (iCREST-UK)
- Author
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David W. Wareham, Neil Woodford, Holly Ciesielczuk, Gregory G. Stone, Li Xu-McCrae, Simon Bracher, Owen Lancaster, Houdini Ho Tin Wu, Frances Davies, Matthew J. Ellington, Hugo Donaldson, G Gopal Rao, Paurus M Irani, Peter M Hawkey, Anita Verma, and Shazad Mushtaq
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Carbapenem ,Adolescent ,medicine.drug_class ,Cost effectiveness ,Avibactam ,030106 microbiology ,Antibiotics ,Ceftazidime ,Microbial Sensitivity Tests ,Carbapenem-resistant enterobacteriaceae ,Polymerase Chain Reaction ,Meropenem ,beta-Lactamases ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,Bacterial Proteins ,Internal medicine ,Prevalence ,polycyclic compounds ,medicine ,Humans ,Pharmacology (medical) ,Etest ,Aged ,Pharmacology ,business.industry ,Enterobacteriaceae Infections ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,United Kingdom ,Anti-Bacterial Agents ,Carbapenem-Resistant Enterobacteriaceae ,Infectious Diseases ,Carbapenems ,chemistry ,Female ,business ,Sentinel Surveillance ,medicine.drug - Abstract
Objectives Although carbapenem susceptibility testing has been recommended for all Enterobacteriaceae from clinical specimens, for practical reasons a carbapenem is not included in many primary antibiotic panels for urine specimens. The 'iCREST' study sought carbapenemase-producing Enterobacteriaceae (CPE) in routine urine specimens yielding Gram-negative growth in five diagnostic laboratories in the UK. We sought also to compare locally and centrally determined MICs of meropenem and ceftazidime/avibactam. Methods Positive growth from up to 2000 urine specimens per laboratory was plated onto chromID® CARBA SMART agar. Suspected CPE colonies were tested locally by Etest for susceptibility to meropenem and ceftazidime/avibactam, and referred to central laboratories for PCR confirmation of CPE status and microbroth MIC determination. Results Twenty-two suspected CPE were identified from 7504 urine specimens. Ten were confirmed by PCR to have NDM (5), IMP (2), KPC (2) or OXA-48-like (1) carbapenemases. Locally determined ceftazidime/avibactam MICs showed complete categorical agreement with those determined centrally by microbroth methodology. The seven ceftazidime/avibactam-resistant isolates (MICs ≥256 mg/L) had NDM or IMP metallo-carbapenemases. Conclusions The frequency of confirmed CPE among Gram-negative urinary isolates was low, at 0.13% (10/7504), but CPE were found in urines at all five participating sites and the diversity of carbapenemase genes detected reflected the complex epidemiology of CPE in the UK. These data can inform local policies about the cost-effectiveness and clinical value of testing Gram-negative bacteria from urine specimens routinely against a carbapenem as part of patient management and/or infection prevention and control strategies.
- Published
- 2017