Effect of varying federal definitions on prevalence and characteristics associated with carbapenem-resistant Enterobacteriaceae in veterans with spinal cord injury.
Effect of varying federal definitions on prevalence and characteristics associated with carbapenem-resistant Enterobacteriaceae in veterans with spinal cord injury.
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DOI：
10.1016/j.ajic.2018.08.001
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发表时间：
2019-03
影响因子：
4.9
通讯作者：
Evans CT
中科院分区：
文献类型：
--
作者：
Fitzpatrick MA;Suda KJ;Jones MM;Burns SP;Poggensee L;Ramanathan S;Evans M;Evans CT
Patients with spinal cord injury (SCI) have an increased risk for multidrug-resistant organisms, including carbapenem-resistant Enterobacteriaceae (CRE). Accurate and easily applied definitions are critical to identify CRE. This study describes CRE and associated characteristics in Veterans with SCI per Centers for Disease Control (CDC) and Department of Veterans Affairs (VA) definitions. Retrospective cohort of Veterans with SCI and ≥1 culture with Escherichia coli, Klebsiella, and/or Enterobacter between 2012-2013. Antibiotic susceptibility criteria of pre-2015 (CDC1) and post-2015 (CDC2) CDC definitions and pre-2017 (VA1) and post-2017 (VA2) VA definitions were used to identify CRE. CRE prevalence and facility characteristics are described for isolates meeting each definition, and agreement among definitions was assessed with Cohen’s kappa. 21,514 isolates cultured from 6,974 Veterans were reviewed; 423 isolates met any CRE definition. Although agreement among definitions was high (κrange=0.82-0.93), definitions including ertapenem resistance led to higher CRE prevalence (VA1=1.7% and CDC2=1.9% vs. VA2=1.4% and CDC1=1.5%). 44/142 VA facilities had ≥1 CRE defined by VA2; 10 facilities accounted for 60% of CRE. Almost all CRE was isolated from high complexity, urban facilities; the South had the greatest proportion of CRE isolates. Varying federal definitions give different CRE frequencies among a high-risk population. Definitions including ertapenem resistance resulted in greater CRE prevalence, but may overemphasize less significant non-carbapenemase producing isolates. Thus, both federal definitions now highlight the importance of carbapenemase testing.
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影响因子：
1.7
作者：
Fitzpatrick, Margaret A.;Suda, Katie J.;Evans, Charlesnika T.
通讯作者：
Evans, Charlesnika T.
影响因子：
4.9
作者：
Ramanathan S;Suda KJ;Fitzpatrick MA;Poggensee L;LaVela SL;Burns SP;Evans CT
通讯作者：
Evans CT
DOI：
10.1186/s12941-017-0191-3
发表时间：
2017-03-29
影响因子：
5.7
作者：
Xu L;Sun X;Ma X
通讯作者：
Ma X
影响因子：
4.5
作者：
Evans, Charlesnika T.;Fitzpatrick, Margaret A.;Suda, Katie J.
通讯作者：
Suda, Katie J.
影响因子：
4.5
作者：
Weiner LM;Webb AK;Limbago B;Dudeck MA;Patel J;Kallen AJ;Edwards JR;Sievert DM
通讯作者：
Sievert DM