#Enterococcal #bacteremia in febrile #neutropenic #children and adolescents with underlying #malignancies, and clinical #impact of #vancomycin resistance (Infection, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infection. 2019 Jun;47(3):417-424. doi: 10.1007/s15010-018-1260-z. Epub 2018 Dec 19.

Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance.

Bae KS1,2, Shin JA1, Kim SK1,3, Han SB4,5, Lee JW1,3, Lee DG2,3,6, Chung NG1,3, Cho B1,3, Jeong DC1,2, Kang JH1,2.

Author information: 1 Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. 2 The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 3 The Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 4 Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea. beomsid@catholic.ac.kr. 5 The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. beomsid@catholic.ac.kr. 6 Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

 

Abstract

PURPOSE:

Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children.

METHODS:

We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes.

RESULTS:

Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000).

CONCLUSIONS:

Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.

KEYWORDS: Child; Enterococcus; Neutropenia; Vancomycin resistance

PMID: 30565009 DOI: 10.1007/s15010-018-1260-z [Indexed for MEDLINE]

Keywords: Enterococci; Bacteremia; Cancer; Antibiotics; Drugs Resistance; Vancomycin.

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Strong #correlation between the rates of intrinsically #antibiotic #resistant species and the rates of acquired resistance in Gram-negative species causing #bacteraemia, #EU/EEA, 2016 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016

Vincent Jarlier 1,2, Liselotte Diaz Högberg 3, Ole E Heuer 3, José Campos 4, Tim Eckmanns 5, Christian G Giske 6,7, Hajo Grundmann 8,Alan P Johnson 9, Gunnar Kahlmeter 10, Jos Monen 11, Annalisa Pantosti 12, Gian Maria Rossolini 13,14, Nienke van de Sande-Bruinsma 15,Alkiviadis Vatopoulos 16, Dorota Żabicka 17, Helena Žemličková 18,19, Dominique L Monnet 3, Gunnar Skov Simonsen 20,21, EARS-Net participants 22

Affiliations: 1 Sorbonne Universités (Paris 06) Inserm Centre d’Immunologie et des Maladies Infectieuses (CIMI), UMR 1135, Paris, France; 2 Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière hospital, Laboratoire de Bactériologie-Hygiène, Paris, France; 3 European Centre for Disease Prevention and Control, Solna, Sweden; 4 Reference and Research Laboratory on Antimicrobial Resistance, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain; 5 Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany; 6 Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 7 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; 8 Medical Center – University of Freiburg, Department for Infection Prevention and Hospital Epidemiology, Freiburg, Germany; 9 National Infection Service, Public Health England, London, United Kingdom; 10 Clinical Microbiology, Central Hospital, Växjö, Sweden; 11 National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 12 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; 13 Department of Experimental and Clinical Medicine, University of Florence, Italy; 14 Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy; 15 Pan American Health Organization/World Health Organization (PAHO/ WHO), Washington DC, United States; 16 Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece; 17 Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland; 18 National Institute of Public Health, National Reference Laboratory for Antibiotics, Prague, Czech Republic; 19 Department of Clinical Microbiology, Faculty of Medicine and University Hospital, Charles University, Hradec Kralove, Czech Republic; 20 Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway; 21 Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway; 22 The members of the group are listed at the end of the article

Correspondence:  Liselotte Diaz Högberg

Citation style for this article: Jarlier Vincent, Diaz Högberg Liselotte, Heuer Ole E, Campos José, Eckmanns Tim, Giske Christian G, Grundmann Hajo, Johnson Alan P,Kahlmeter Gunnar, Monen Jos, Pantosti Annalisa, Rossolini Gian Maria, van de Sande-Bruinsma Nienke, Vatopoulos Alkiviadis, Żabicka Dorota, Žemličková Helena,Monnet Dominique L, Simonsen Gunnar Skov, EARS-Net participants. Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016. Euro Surveill. 2019;24(33):pii=1800538. https://doi.org/10.2807/1560-7917.ES.2019.24.33.1800538

Received: 03 Oct 2018;   Accepted: 01 Apr 2019

 

Abstract

Background

Antibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.

Aim

Our objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species and the proportions of selected acquired resistance traits within these species.

Method

We used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.

Results

The country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacterspp. combined (PSEACI) accounted for 5.5% to 39.2% of isolates (median: 10.1%). Similarly, large national differences were noted for the percentages of acquired non-susceptibility to third-generation cephalosporins, carbapenems and fluoroquinolones. There was a strong positive rank correlation between the country-specific percentages of PSEACI and the percentages of non-susceptibility to the above antibiotics in all four species (rho > 0.75 for 10 of the 11 pairs of variables tested).

Conclusion

Countries with the highest proportion of P. aeruginosa and Acinetobacter spp. were also those where the rates of acquired non-susceptibility in all four studied species were highest. The differences are probably related to national differences in antibiotic consumption and infection prevention and control routines.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Bacteremia; EU.

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#Shock and Early #Death in #Hematologic Patients with Febrile #Neutropenia (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Shock and Early Death in Hematologic Patients with Febrile Neutropenia

Mariana Guarana, Marcio Nucci, Simone A. Nouér

DOI: 10.1128/AAC.01250-19

 

ABSTRACT

Empiric antibiotic therapy with a betalactam is standard of care in febrile neutropenia (FN), and is given to prevent early death. The addition of vancomycin is recommended in certain circumstances but the quality of evidence is low, reflecting the lack of clinical data. In order to characterize the epidemiology of early death and shock in FN, we reviewed all episodes of FN from 2003 to 2017 at University Hospital, Federal University of Rio de Janeiro, and looked at factors associated with shock at first fever and early death (within 3 days from first fever) by univariate and multivariate analyses. Among 1305 episodes of FN, shock occurred in 42 episodes (3.2%) and early death in 15 (1.1%). Predictors of shock were bacteremia due to Escherichia coli (odds ratio [OR] 8.47, 95% confidence interval [95% CI] 4.08 – 17.55, p<0.001), Enterobacter sp. (OR 7.53, 95% CI 1.60 – 35.33, p=0.01), and Acinetobacter sp. (OR 6.95, 95% CI 1.49 – 32.36, p=0.01). Factors associated with early death were non-Hodgkin lymphoma (OR 3.57, 95% CI 1.18-10.73, p=0.02), pneumonia (OR 21.36, 95% CI 5.72-79.72, p<0.001), shock (OR 11.64, 95% CI 2.77-48.86, p=0.01) and bacteremia due to Klebsiella pneumoniae (OR 5.91, 95% CI 1.11-31.47, p=0.03). Adequate empiric antibiotic therapy was protective (OR 0.23, 95% CI 0.07 – 0.81, p=0.02). Shock or early death was not associated with Gram-positive bacteremia, catheter-related, skin or soft tissue infection, or inadequate Gram-positive coverage. These data challenge guidelines recommendations for the empiric use of vancomycin at first fever in neutropenic patients.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Vancomycin; Sepsis; Bacteremia; Enterobacteriaceae.

——

Oral #antibiotics for the #treatment of gram negative #bloodstream #infections: a retrospective comparison of three classes (J Glob Antimicrob Resist., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Glob Antimicrob Resist. 2019 Aug 4. pii: S2213-7165(19)30192-4. doi: 10.1016/j.jgar.2019.07.026. [Epub ahead of print]

Oral antibiotics for the treatment of gram negative blood stream infections: a retrospective comparison of three classes.

Nisly SA1, McClain DL2, Fillius AG3, Davis KA4.

Author information: 1 School of Pharmacy, Wingate University, Clinical Pharmacist, Internal Medicine, Wake Forest Baptist Health, 515 N. Main St, Wingate, NC 28174. Electronic address: s.nisly@wingate.edu. 2 School of Pharmacy Alumna, Wingate University, 515 N. Main St, Wingate, NC 28174. Electronic address: do.mcclain@wingate.edu. 3 School of Pharmacy Alumna, Wingate University, 515 N. Main St, Wingate, NC 28174. Electronic address: am.fillius@wingate.edu. 4 Clinical Pharmacist, Internal Medicine, Department of Pharmacy, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston Salem, NC 27157. Electronic address: kydavis@wakehealth.edu.

 

Abstract

BACKGROUND:

Treatment of bacteremia with oral antibiotics has the potential to reduce hospital length of stay, treatment costs, and line related complications. To date, small trials have supported use of specific classes of antibiotics, primarily fluoroquinolones (FQ), in the treatment of gram-negative blood stream infections (GNBSI). At present, limited data exists evaluating treatment with beta-lactams (BL) or trimethoprim-sulfamethoxazole (TMP-SMX).

OBJECTIVE:

The purpose of this study was to compare the treatment of GNBSI across three different oral antibiotic classes.

METHODS:

A retrospective cohort of hospitalized patients with a GNBSI receiving initial intravenous antibiotic therapy followed by step-down oral therapy was conducted. Patients were divided into one of three oral antibiotic treatment groups: FQ, BL, or TMP-SMX. The composite primary endpoint was treatment failure, comprised of 30-day mortality, clinical relapse, or transition back to intravenous antibiotics. Additional endpoints included secondary infections and individual components within the primary endpoint. Categorical endpoints were analyzed using X2 or Fisher’s exact while continuous variables were assessed with a one-way ANOVA.

RESULTS:

A total of 204 patients were included in the analysis. The majority of patients received FQ (n=136; 67%), followed by BL (n=46; 22%) and TMP-SMX (n=22;11%). Treatment failure occurred in 15 (7%) patients with no significance found between groups. Likewise, individual composite outcomes and secondary outcomes demonstrated no statistical significance.

CONCLUSION AND RELEVANCE:

Transitioning to oral antibiotics to complete GNBSI treatment can offer many advantages. As FQ resistance increases, data supporting use of BL or TMP-SMX in treatment of GNBSI will become essential.

Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Antibiotics; Bacteremia; Gram-negative; Oral

PMID: 31390537 DOI: 10.1016/j.jgar.2019.07.026

Keywords: Antibiotics; Drugs Resistance; Bacteremia.

——

#Mortality dynamics of #Pseudomonas aeruginosa #bloodstream #infections and the influence of defective OprD on mortality: prospective observational study (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Mortality dynamics of Pseudomonas aeruginosabloodstream infections and the influence of defective OprD on mortality: prospective observational study

Eun-Jeong Yoon, Dokyun Kim, Hyukmin Lee, Hye Sun Lee, Jeong Hwan Shin, Yoon Soo Park, Young Ah Kim, Jong Hee Shin, Kyeong Seob Shin, Young UhSeok Hoon Jeong

Journal of Antimicrobial Chemotherapy, dkz245, https://doi.org/10.1093/jac/dkz245

Published: 24 June 2019

 

Abstract

Background

To assess the mortality dynamics of patients with Pseudomonas aeruginosabloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality.

Methods

A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics.

Results

During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency.

Conclusions

BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa(17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

Topic: pseudomonas aeruginosa – carbapenem – follow-up – mortality  – bloodstream infections – sequential organ failure assessment scores

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Pseudomonas aeruginosa; Bacteremia.

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IncI1 ST3 and IncI1 ST7 #plasmids from CTX-M-1-producing #Escherichia coli obtained from #patients with #bloodstream infections are closely related to plasmids from E. coli of #animal origin (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

IncI1 ST3 and IncI1 ST7 plasmids from CTX-M-1-producing Escherichia coli obtained from patients with bloodstream infections are closely related to plasmids from E. coli of animal origin

Adam Valcek, Louise Roer, Søren Overballe-Petersen, Frank Hansen, Valeria Bortolaia, Pimlapas Leekitcharoenphon, Helle B Korsgaard, Anne Mette Seyfarth, Rene S Hendriksen, Henrik Hasman, Anette M Hammerum

Journal of Antimicrobial Chemotherapy, dkz199, https://doi.org/10.1093/jac/dkz199

Published: 14 May 2019

 

Abstract

Objectives

Fully sequenced IncI1 plasmids obtained from CTX-M-1-producing Escherichia coli of human and animal origin were compared.

Methods

Twelve E. coli isolates sharing identical ESBL genes and plasmid multilocus STs sequenced on Illumina and MinION platforms were obtained from the Danish antimicrobial resistance surveillance programme, DANMAP. After de novoassembly, the sequences of plasmids harbouring blaCTX-M-1 were manually curated and ORFs annotated. Within-group comparisons were performed separately for the IncI1 ST3 plasmid type and the IncI1 ST7 plasmid type. The IncI1 ST3 plasmid group was obtained from 10 E. coli isolates (2 from patients with bloodstream infections, 6 from food and 2 from animals). The IncI1 ST7 plasmids originated from E. coli isolates obtained from a patient with bloodstream infection and from a pig. Sequences of IncI1 ST3 and IncI1 ST7 plasmids harbouring blaCTX-M-1 with determined origin were retrieved from GenBank and used for comparison within the respective group.

Results

The 10 IncI1 ST3 blaCTX-M-1 plasmids were highly similar in structure and organization with only minor plasmid rearrangements and differences in the variable region. The IncI1 ST7 blaCTX-M-1 plasmids also showed high similarity in structure and organization. The high level of similarity was also observed when including plasmids from E. coli of animal origin from Australia, Switzerland, the Netherlands and France.

Conclusions

This study shows broad spread of a very successful CTX-M-1-producing IncI1 type plasmid among E. coli of both human and animal origin.

Topic: plasmids – drug resistance, microbial – food – genes – ichthyosis, x-linked – sequence tagged sites – escherichia coli – sodium thiosulfate – bloodstream infections – genbank

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; E. Coli; Bacteremia; Pigs; Human; Plasmids.

——

Effect of #carbapenem #resistance on outcomes of #bloodstream #infection caused by #Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study

Andrew J Stewardson, MBBS  †, Kalisvar Marimuthu, MBBS †, Sharmila Sengupta, MD, Arthur Allignol, PhD, Maisra El-Bouseary, PhD, Maria J Carvalho, PhD, Brekhna Hassan, PhD, Monica A Delgado-Ramirez, MD, Anita Arora, MD, Ruchika Bagga, MD, Alex K Owusu-Ofori, MD, Joseph O Ovosi, MBBS, Shamsudin Aliyu, MBBS, Hala Saad, MD, Prof Souha S Kanj, MD, Prof Basudha Khanal, MD, Prof Balkrishna Bhattarai, MD, Samir K Saha, PhD, Jamal Uddin, MPH, Purabi Barman, MD, Latika Sharma, MD, Tarek El-Banna, PhD, Rabaab Zahra, PhD, Mansab Ali Saleemi, MPhil, Amarjeet Kaur, MD, Kenneth Iregbu, FWACP, Nkolika SC Uwaezuoke, FWACP, Pierre Abi Hanna, MD, Rita Feghali, MD, Prof Ana L Correa, MD, Maria I Munera, MD, Thi Anh Thu Le, MD, Thi Thanh Nga Tran, MD, Chimanjita Phukan, MD, Chiranjita Phukan, MD, Sandra L Valderrama-Beltrán, MD, Prof Carlos Alvarez-Moreno, MD, Prof Timothy R Walsh, DSc, Prof Stephan Harbarth, MD

Published: April 29, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30792-8

 

Summary

Background

Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.

Methods

The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis.

Findings

Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades.

Interpretation

Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs.

Funding

bioMérieux.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Enterobacteriaceae; Bacteremia.

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