Explore the vast range of titles available.

A carbapenem-resistant Enterobacterales outbreak at a veterinary teaching hospital in the United States increased urgency for improved communication among diagnostic laboratories, public health authorities, veterinarians, and pet owners. Kansas State University, University of Missouri, Kansas Department of Health and Environment, and Veterinary Laboratory Investigation and Response Network created a surveillance, storage, and reporting protocol for veterinary antimicrobial-resistant bacteria; determined frequency of those bacteria in companion animals during 2018-2021; and created educational flyers for veterinarians and pet owners. We recommend a One Health strategy to create efficient surveillance programs to identify and report antimicrobial-resistant bacteria and educate veterinarians and pet owners about transmission risks.

We conducted surveillance for carbapenem-resistant Enterobacterales (CRE) during 2016–2020 at 10 US sites and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) during 2019–2020 at 6 US sites. Among 159 CRE cases in children (median age 5 years), CRE was isolated from urine for 131 (82.4%) and blood from 20 (12.6%). Annual CRE incidence rate (cases/100,000 population) was 0.47–0.87. Among 207 ESBL-E cases in children (median age 6 years), ESBL-E was isolated from urine of 196 (94.7%) and blood of 8 (3.9%). Annual ESBL-E incidence rate was 26.5 in 2019 and 19.63 in 2020. CRE and ESBL-E rates were >2-fold higher among infants than other age groups. Most CRE and ESBL-E cases were healthcare-associated community-onset (68 [43.0%] for CRE vs. 40 [23.7%] for ESBL-E) or community-associated (43 [27.2%] for CRE vs. 109 [64.5%] for ESBL-E). Programs to detect, prevent, and treat multidrug-resistant infections must include pediatric populations (particularly the youngest) and outpatient settings.

Gastrointestinal carriage of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) presents a critical public health threat globally. However, in resource-constrained countries with poor sanitation, inadequate drinking water, and limited microbiology laboratories like Kenya, epidemiological data of these strains is limited. This study assessed the gastrointestinal carriage of ESBL-E and the risk factors for colonization among children (≤ 5 years) in the inpatient department (IPD) and outpatient department (OPD). This was a hospital-based cross-sectional study at Thika Level 5 Hospital, Kenya, from February to June 2023. In total, 540 participants (OPD: 270, IPD: 270) were recruited, using systematic random sampling and consecutive sampling in OPD and IPD, respectively. Children admitted for less than 48 h in the paediatrics ward and those with a prior history of hospitalization (≤ 3 months) in OPD were excluded. Demographic data were collected using a well-structured questionnaire. Following the standard microbiology methods, stool or rectal swab samples were cultured, with the identity and antimicrobial susceptibility of isolates elucidated by automated platforms. The overall ESBL-E gastrointestinal carriage rate was 35.4% (191/540), and was highest among outpatients at 40.4% (109/270). Isolates demonstrated co-resistance to aminoglycosides (43–52%), quinolones (52–62%), carbapenems (44–50%), and sulfonamides (92–97%). They were more susceptible to piperacillin/tazobactam (67–95%) and colistin (96–99%). Carbapenemase-producing Enterobacterales (CPE) co-carriage rate was 17.6% (16/91), with similar rates for inpatients (50%, 8/16) and outpatients (50%, 8/16). Escherichia coli was the predominant ESBL-E overall (82.2%, 157/191), among outpatients (83.5%, 91/109), and inpatients (80.5%, 66/82), and was also the main CPE (overall: 81.3%, 13/16; OPD: 75%, 6/8; IPD: 87.5%, 7/8). Independent predictors of colonization included child age (adjusted odds ratio (OR): 1.60, p  = 0.045) and a history of antimicrobial use from retail pharmacies without a clinician’s prescription (adjusted OR: 0.18, p  = 0.047). This study demonstrates a substantial burden of gastrointestinal carriage of ESBL-E and CPE co-carriage among children (≤ 5 years), with E. coli being the predominant organism. Age less than two years and a history of exposure to non-prescribed antimicrobials were independent factors for colonization. Efforts to limit exposure to contaminated environments and targeted antimicrobial stewardship initiatives are required to mitigate AMR in the current study setting.

Gastrointestinal carriage of antimicrobial-resistant bacteria, especially carbapenemase-producing Enterobacterales (CPE), presents a critical public health threat globally. However, in many resource-constrained countries, epidemiological data on CPE is limited. Here, we assessed gastrointestinal carriage and associated factors of CPE among inpatient and outpatient children (≤ 5 years). This hospital-based cross-sectional study was conducted at Thika Level 5 Hospital in Kenya from February to June 2023. In total, 540 participants were recruited from outpatient (270) and inpatient (270) children, excluding those admitted for < 48 h and outpatients with ≤ 3 months hospitalization history. Demographic data were collected using a questionnaire, and stool or swab samples were cultured following standard microbiology methods. Automated platforms were used for isolates identification and antimicrobial susceptibility testing. Gastrointestinal carriage rate of CPE was 9.6%, 95% confidence interval (CI): 6.39–13.79% (26/270) among the inpatients and 5.9%, 95% CI: 3.42–9.45% (16/270) among the outpatients. The carbapenemase-producing Enterobacterales were predominated by multidrug-resistant Escherichia coli from inpatients (22/22, 100%) and outpatients (8/10, 80%). The colonization rate was higher among inpatients who were presenting with chills (aOR = 10.57, p  = 0.008). We report a high gastrointestinal carriage of CPE among children (≤ 5 years). Strict adherence to colonization screening, and antimicrobial stewardship policies are critical to control CPE dissemination in the current study area and beyond.

The global emergence of carbapenemase-producing bacteria capable of hydrolyzing the once effective carbapenem antibiotics is considered a contemporary public health concern. Carbapenemase enzymes, once constrained to isolates of Klebsiella pneumoniae, are now routinely reported in different bacteria within the Enterobacterales order of bacteria, creating the acronym CRE which now defines Carbapenem-Resistant Enterobacterales. CRE harboring different types of enzymes, including the most prevalent types KPC, VIM, IMP, NDM, and OXA-48, are now routinely reported and more importantly, are now frequently present in many infections world-wide. Defining and updating the contemporary epidemiology of both the US and global burden of carbapenem-resistant infections is now more important than ever. This review describes the global distribution and continued evolution of carbapenemases which continue to spread at alarming rates. Informed understanding of the current epidemiology of CRE, coupled with advances in antibiotic options, and the use rapid diagnostics offers the potential for rapid identification and management of carbapenem-resistant infections.Plain Language SummaryCarbapenems are a subclass of antibiotic used to treat infections caused by Gram-negative bacteria, particularly in resistant and multidrug-resistant (MDR) infections where penicillin and cephalosporins are no longer effective. However, carbapenem-resistant Enterobacterales (CRE) have emerged due to acquisition of carbapenemase enzymes, most prevalent types are KPC, VIM, IMP, NDM, and OXA-48; infections caused by these bacteria have disseminated globally in both the healthcare and community setting. Resulting in a significant public health issue and clinical burden, these CRE infections are associated with increased morbidity and mortality, in part because carbapenems are the last therapeutic line of defense against resistant and MDR bacterial infections. The author wanted to investigate current US and global epidemiology of carbapenem-resistant infections, identify factors driving changes, as well as diagnostic technologies, and reporting or surveillance methods in place to track trends and inform therapeutic protocols and development. Overall, carbapenemase enzymes originally only reported in one country or region in 2006-2007, by 2013 and onwards have spread not only to surrounding countries but to other continents, which has impacted antibiotic resistance patterns and susceptibility. Increasing human travel and environmental factors, such as livestock care, food distribution, sewage, and recreational water, have contributed to global dissemination of CRE. Active surveillance programs are key to tracking resistance in real time, in order to update susceptibility breakpoints and epidemiology, which can inform antibiotic treatment choices, management guidelines, and the development of new therapeutics. Together, these factors will help to identify, control, and treat the spread of carbapenem resistance.

Background In Japan, carbapenem-resistant Enterobacterales (CRE) infections were incorporated into the National Epidemiological Surveillance of Infectious Diseases (NESID) in 2014, necessitating mandatory reporting of all CRE infections cases. Subsequently, pathogen surveillance was initiated in 2017, which involved the collection and analysis of CRE isolates from reported cases to assess carbapenemase gene possession. In this surveillance, CRE is defined as (i) minimum inhibitory concentration (MIC) of meropenem ≥2 mg/L (MEPM criteria) or (ii) MIC of imipenem ≥2 mg/L and MIC of cefmetazole ≥64 mg/L (IPM criteria). This study examined whether the current definition of CRE surveillance captures cases with a clinical and public health burden. Methods CRE isolates from reported cases were collected from the public health laboratories of local governments, which are responsible for pathogen surveillance. Antimicrobial susceptibility tests were conducted on these isolates to assess compliance with the NESID CRE definition. The NESID data between April 2017 and March 2018 were obtained and analyzed using antimicrobial susceptibility test results. Results In total, 1681 CRE cases were identified during the study period, and pathogen surveillance data were available for 740 (44.0%) cases. Klebsiella aerogenes and Enterobacter cloacae complex were the dominant species, followed by Klebsiella pneumoniae and Escherichia coli . The rate of carbapenemase gene positivity was 26.5% (196/740), and 93.4% (183/196) of these isolates were of the IMP type. Meanwhile, 315 isolates were subjected to antimicrobial susceptibility testing. Among them, 169 (53.7%) fulfilled only the IPM criteria (IPM criteria-only group) which were susceptible to meropenem, while 146 (46.3%) fulfilled the MEPM criteria (MEPM criteria group). The IPM criteria-only group and MEPM criteria group significantly differed in terms of carbapenemase gene positivity (0% vs. 67.8%), multidrug resistance rates (1.2% vs. 65.8%), and mortality rates (1.8% vs 6.9%). Conclusion The identification of CRE cases based solely on imipenem resistance has had a limited impact on clinical management. Emphasizing resistance to meropenem is crucial in defining CRE, which pose both clinical and public health burden. This emphasis will enable the efficient allocation of limited health and public health resources and preservation of newly developed antimicrobials.

Infectious disease outbreaks have caused thousands of deaths and hospitalizations, along with severe negative global economic impacts. Among these, infections caused by antimicrobial-resistant microorganisms are a major growing concern. The misuse and overuse of antimicrobials have resulted in the emergence of antimicrobial resistance (AMR) worldwide. Carbapenem-resistant Enterobacterales (CRE) are among the bacteria that need urgent attention globally. The emergence and spread of carbapenem-resistant bacteria are mainly due to the rapid dissemination of genes that encode carbapenemases through horizontal gene transfer (HGT). The rapid dissemination enables the development of host colonization and infection cases in humans who do not use the antibiotic (carbapenem) or those who are hospitalized but interacting with environments and hosts colonized with carbapenemase-producing (CP) bacteria. There are continuing efforts to characterize and differentiate carbapenem-resistant bacteria from susceptible bacteria to allow for the appropriate diagnosis, treatment, prevention, and control of infections. This review presents an overview of the factors that cause the emergence of AMR, particularly CRE, where they have been reported, and then, it outlines carbapenemases and how they are disseminated through humans, the environment, and food systems. Then, current and emerging techniques for the detection and surveillance of AMR, primarily CRE, and gaps in detection technologies are presented. This review can assist in developing prevention and control measures to minimize the spread of carbapenem resistance in the human ecosystem, including hospitals, food supply chains, and water treatment facilities. Furthermore, the development of rapid and affordable detection techniques is helpful in controlling the negative impact of infections caused by AMR/CRE. Since delays in diagnostics and appropriate antibiotic treatment for such infections lead to increased mortality rates and hospital costs, it is, therefore, imperative that rapid tests be a priority.

Background We aimed to identify the risk factors for subsequent carbapenem‐resistant Enterobacterales (CRE) infections in patients with initial rectal colonization with CRE. Methods We conducted a retrospective case–control study on inpatients with rectal CRE colonization between January 2019 and December 2020. Clinical and microbiological data were extracted from hospital patients' medical records and the clinical microbiology laboratory. Risk factors were assessed and compared between patients with CRE colonization who had subsequent infections and those who did not have infections. Results Among 1064 patients screened for CRE, we enrolled 205 patients with rectal CRE colonization. Among the 205 colonized bacteria, 78.5% were Klebsiella pneumoniae, with 62.9% of them producing Klebsiella pneumoniae carbapenemase (KPC). Multivariate logistic regression analysis revealed that more than three times hospitalization (p = 0.026), being in a coma (p = 0.019), and exposure to carbapenems (p = 0.015) were independent risk factors for CRE clinical infection among CRE rectal carriers. Conclusion This is the first study to report that more than three times hospitalization is an independent risk factor for subsequent CRE clinical infection in CRE intestinal carriers. Carbapenem‐resistant Klebsiella pneumoniae is the most important species isolated from hospitalized CRE rectal carriers and is the most common cause of subsequent infections. To analyze the risk factors for subsequential clinical infection in hospitalized patients with rectal carbapenem‐resistant Enterobacterales (CRE) carriage and to provide reference for clinical prevention CRE infections. Univariate analysis was conducted to detect the risk factors of subsequent infection. Through multivariable logistic regression analysis of these factors, it was found that more than three times hospitalization, coma, and recent use of carbapenems were independent risk factors for CRE clinical infection in CRE rectal carriers.

Objective To describe the distribution of major antimicrobial resistance phenotypes in a tertiary maternal and child health hospital from 2021 to 2024, to assess their temporal trends and seasonal patterns, and to explore possible phase-specific changes, so as to provide evidence for infection prevention and control and antimicrobial stewardship in maternal and child health settings. Methods This was a single-center ecological longitudinal time-series study. Positive bacterial isolates recovered from clinical specimens submitted from hospitalized patients at Luoyang Maternal and Child Health Hospital between January 1, 2021 and December 31, 2024 were collected. A first-isolate deduplication strategy was applied, whereby only the first isolate within 30 days was retained for the same patient, bacterial species, and specimen type. Resistance phenotypes were uniformly defined according to CLSI criteria. Descriptive analyses were performed for carbapenem-resistant Enterobacterales (CRE), extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Pseudomonas aeruginosa (CRPAE). Among these, CRE, ESBL-E, and MRSA were included in the main trend analyses, whereas CRPAE was presented descriptively because of its low detection frequency. Differences across years, wards, and specimen types were compared using the χ² test. Quarterly trends and potential breakpoints were assessed using single-breakpoint segmented log-linear Poisson regression. Monthly generalized linear models (GLMs) based on aggregated data were used to evaluate overall temporal trends and seasonality. Results A total of 8,467 clinical isolates meeting the first-isolate criteria were included from 2021 to 2024. Annual analyses showed that ESBL-E and MRSA constituted the major resistance burden. The detection rate of ESBL-E decreased from 9.62% in 2021 to 3.55% in 2024, and that of CRE decreased from 2.52% to 0.34%, whereas MRSA increased from 10.96% to 12.73%. CRPAE remained at a low level throughout the study period (0.05%–0.30%). In terms of ward distribution, pediatric-related wards and the NICU accounted for a relatively high proportion, suggesting that the major resistance burden was more concentrated in neonatal and pediatric clinical units. Monthly GLM analyses showed that, after adjustment for seasonality, CRE exhibited an overall downward trend (IRR = 0.946, 95% CI: 0.930–0.962, P  < 0.001), ESBL-E showed a slight downward trend (IRR = 0.992, 95% CI: 0.985–1.000, P  = 0.041), and MRSA showed a slight upward trend (IRR = 1.005, 95% CI: 1.000–1.010, P  = 0.031). All three phenotypes showed varying degrees of seasonal fluctuation. Exploratory quarterly segmented regression further suggested possible phase-specific changes in some resistance phenotypes; however, given the limited number of quarterly time points, these breakpoint findings should be interpreted with caution. Conclusions From 2021 to 2024, the major resistance burden in this maternal and child health hospital was still mainly attributable to ESBL-E and MRSA. Although the overall detection rate of CRE was low, it still warrants continued attention in key wards. CRPAE was infrequently detected and should be regarded as a supplementary descriptive finding only. Marked heterogeneity was observed across resistance phenotypes in ward distribution, specimen sources, and temporal patterns. These findings provide single-center surveillance evidence to support stratified monitoring, targeted infection prevention and control, and antimicrobial stewardship in maternal and child health hospitals; however, their generalizability should be interpreted cautiously in conjunction with data from other institutions.

Dissemination of carbapenemase-encoding plasmids by horizontal gene transfer in multidrug-resistant bacteria is the major driver of rising carbapenem-resistance, but the conjugative mechanics and evolution of clinically relevant plasmids are not yet clear. We performed whole-genome sequencing on 1,215 clinical Enterobacterales isolates collected in Singapore during 2010–2015. We identified 1,126 carbapenemase-encoding plasmids and discovered pKPC2 is becoming the dominant plasmid in Singapore, overtaking an earlier dominant plasmid, pNDM1. pKPC2 frequently conjugates with many Enterobacterales species, including hypervirulent Klebsiella pneumoniae, and maintains stability in vitro without selection pressure and minimal adaptive sequence changes. Furthermore, capsule and decreasing taxonomic relatedness between donor and recipient pairs are greater conjugation barriers for pNDM1 than pKPC2. The low fitness costs pKPC2 exerts in Enterobacterales species indicate previously undetected carriage selection in other ecological settings. The ease of conjugation and stability of pKPC2 in hypervirulent K. pneumoniae could fuel spread into the community.