Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review

Frontiers in Cellular and Infection Microbiology

Shio-Shin Jean¹  Wen-Chien Ko²  Yu-Lin Lee³  Po-Ren Hsueh⁴  Hsin-Yu Chen⁵  Po-Yu Liu⁶  Min-Chi Lu⁷ 

[1] Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;Department of Emergency Medicine, Department of Emergency Medicine and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;Department of Internal Medicine and Center for Infection Control, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan;Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan;Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan;Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan;

关键词: Enterobacteriaceae;    long-term care facilities;    oxacillinase;    carbapenemases;    metallo-beta-lactamase;   

DOI  :  10.3389/fcimb.2021.601968

来源: Frontiers

【 摘 要 】

The emergence of carbapenem-resistant Enterobacterales (CRE) has become a major public health concern. Moreover, its colonization among residents of long-term care facilities (LTCFs) is associated with subsequent infections and mortality. To further explore the various aspects concerning CRE in LTCFs, we conducted a literature review on CRE colonization and/or infections in long-term care facilities. The prevalence and incidence of CRE acquisition among residents of LTCFs, especially in California, central Italy, Spain, Japan, and Taiwan, were determined. There was a significant predominance of CRE in LTCFs, especially in high-acuity LTCFs with mechanical ventilation, and thus may serve as outbreak centers. The prevalence rate of CRE in LTCFs was significantly higher than that in acute care settings and the community, which indicated that LTCFs are a vital reservoir for CRE. The detailed species and genomic analyses of CRE among LTCFs reported that Klebsiella pneumoniae is the primary species in the LTCFs in the United States, Spain, and Taiwan. KPC-2-containing K. pneumoniae strains with sequence type 258 is the most common sequence type of KPC-producing K. pneumoniae in the LTCFs in the United States. IMP-11- and IMP-6-producing CRE were commonly reported among LTCFs in Japan. OXA-48 was the predominant carbapenemase among LTCFs in Spain. Multiple risk factors associated with the increased risk for CRE acquisition in LTCFs were found, such as comorbidities, immunosuppressive status, dependent functional status, usage of gastrointestinal devices or indwelling catheters, mechanical ventilation, prior antibiotic exposures, and previous culture reports. A high CRE acquisition rate and prolonged CRE carriage duration after colonization were found among residents in LTCFs. Moreover, the patients from LTCFs who were colonized or infected with CRE had poor clinical outcomes, with a mortality rate of up to 75% in infected patients. Infection prevention and control measures to reduce CRE in LTCFs is important, and could possibly be controlled via active surveillance, contact precautions, cohort staffing, daily chlorhexidine bathing, healthcare-worker education, and hand-hygiene adherence.

【 授权许可】

CC BY