Neil Osterweil

BOSTON – Bacteremia secondary to pneumonia caused by carbepenem-resistant Klebsiella pneumoniae carries a high mortality rate, but combination antimicrobial regimens involving polymyxins, tigecycline, or carbepenems offer a better shot at survival compared with monotherapy, according to the findings of an observational treatment study conducted at two medical centers.

Among 41 patients infected with K. pneumoniae bacteria that produce the drug-resistant Klebsiella pneumoniae Carbepenemase (KPC), 14-day mortality was 24%, and 28-day mortality was 35%, Dr. Zubair A. Qureshi reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Mortality was increased when patients received monotherapy with either colistin (4 deaths among 7 patients) or tigecycline (3 of 5 patients). However, there were no deaths within 28 days among patients treated with either colistin or tigecycline added to any carbepenem, even when the infectious organism was reported to be nonsusceptible to carbepenems, said Dr. Qureshi of the division of internal medicine at the University of Pittsburgh Medical Center.

He noted that the preliminary findings are supported by a recent review of KPC infections that documented better clinical outcomes with combination therapy compared with monotherapy (J. Antimicrob. Chemother. 2010;6:1119-25).

KPC type beta-lactamases have been shown to confer either decreased susceptibility or resistance to virtually all beta-lactam antibiotics, including the carbapenem class agents imipenem, meropenem, and ertapenem.

Investigators at the University of Pittsburgh and St. Luke’s-Roosevelt Hospital Center in New York City conducted the single-arm observational study of treatment outcomes in patients with bacteremia due to KPC-producing K. pneumoniae. Patients were screened for the presence of KPC by reduced susceptibility to ertapenem, which was confirmed with polymerase chain reaction.

The authors looked at risk factors, antimicrobial therapy, and in-hospital mortality rates. They identified 41 patients (24 women, 17 men) with KPC-producing K. pneumoniae, with a median age of 62 years (range 25-90 years). All of the cases appeared to have been acquired in either the hospital (78%) or other health care settings such as long-term care facilities. There were no identified cases of community-acquired infections.

The source of the bacteremia was vascular catheters in 29% of the cases, pneumonia in 27%, urinary tract in 15%, intra-abdominal in 4%, and superficial wounds in 4%. The source was unknown in the remaining patients.

The primary risk factor was immunocompromised status, either from a transplant, malignancy, diabetes, connective tissue disease, chronic renal failure, or HIV infection. In all, 76% of patients had recently received antimicrobial agents, and 41% were nursing-home residents.

Deaths occurred in 7 of 11 patients with pneumonia as the source of bacteremia, 3 of 12 patients with vascular catheters as the source, 1 of 6 with urinary catheter-based infections, and 3 of 12 from other or unknown sources.

When they looked at 28-day mortality in patients who received definitive therapy, they found that any combination was associated with a significantly lower rate than monotherapy (6% vs. 59%, P = .002). The analysis did not include two patients who were lost to follow-up.

The regimens consisted of various combinations of polymyxins, tigecycline, and carbapenems.

“The combination of colistin and carbepenem appears to be superior to any other antibiotic combination, but there is a need for more observation as well as randomized clinical trials to help define the optimal treatment for KPC infections,” Dr. Qureshi said.

Disclosures: Dr. Qureshi reported having no conflicts of interest. Several of his colleagues reported receiving consulting fees from AstraZeneca, Merck, Novartis, Leo Pharmaceuticals, Three Rivers Pharmaceuticals, and/or Johnson & Johnson.

BOSTON – Bacteremia secondary to pneumonia caused by carbepenem-resistant Klebsiella pneumoniae carries a high mortality rate, but combination antimicrobial regimens involving polymyxins, tigecycline, or carbepenems offer a better shot at survival compared with monotherapy, according to the findings of an observational treatment study conducted at two medical centers.

Among 41 patients infected with K. pneumoniae bacteria that produce the drug-resistant Klebsiella pneumoniae Carbepenemase (KPC), 14-day mortality was 24%, and 28-day mortality was 35%, Dr. Zubair A. Qureshi reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Mortality was increased when patients received monotherapy with either colistin (4 deaths among 7 patients) or tigecycline (3 of 5 patients). However, there were no deaths within 28 days among patients treated with either colistin or tigecycline added to any carbepenem, even when the infectious organism was reported to be nonsusceptible to carbepenems, said Dr. Qureshi of the division of internal medicine at the University of Pittsburgh Medical Center.

He noted that the preliminary findings are supported by a recent review of KPC infections that documented better clinical outcomes with combination therapy compared with monotherapy (J. Antimicrob. Chemother. 2010;6:1119-25).

KPC type beta-lactamases have been shown to confer either decreased susceptibility or resistance to virtually all beta-lactam antibiotics, including the carbapenem class agents imipenem, meropenem, and ertapenem.

Investigators at the University of Pittsburgh and St. Luke’s-Roosevelt Hospital Center in New York City conducted the single-arm observational study of treatment outcomes in patients with bacteremia due to KPC-producing K. pneumoniae. Patients were screened for the presence of KPC by reduced susceptibility to ertapenem, which was confirmed with polymerase chain reaction.

The authors looked at risk factors, antimicrobial therapy, and in-hospital mortality rates. They identified 41 patients (24 women, 17 men) with KPC-producing K. pneumoniae, with a median age of 62 years (range 25-90 years). All of the cases appeared to have been acquired in either the hospital (78%) or other health care settings such as long-term care facilities. There were no identified cases of community-acquired infections.

The source of the bacteremia was vascular catheters in 29% of the cases, pneumonia in 27%, urinary tract in 15%, intra-abdominal in 4%, and superficial wounds in 4%. The source was unknown in the remaining patients.

The primary risk factor was immunocompromised status, either from a transplant, malignancy, diabetes, connective tissue disease, chronic renal failure, or HIV infection. In all, 76% of patients had recently received antimicrobial agents, and 41% were nursing-home residents.

Deaths occurred in 7 of 11 patients with pneumonia as the source of bacteremia, 3 of 12 patients with vascular catheters as the source, 1 of 6 with urinary catheter-based infections, and 3 of 12 from other or unknown sources.

When they looked at 28-day mortality in patients who received definitive therapy, they found that any combination was associated with a significantly lower rate than monotherapy (6% vs. 59%, P = .002). The analysis did not include two patients who were lost to follow-up.

The regimens consisted of various combinations of polymyxins, tigecycline, and carbapenems.

“The combination of colistin and carbepenem appears to be superior to any other antibiotic combination, but there is a need for more observation as well as randomized clinical trials to help define the optimal treatment for KPC infections,” Dr. Qureshi said.

Disclosures: Dr. Qureshi reported having no conflicts of interest. Several of his colleagues reported receiving consulting fees from AstraZeneca, Merck, Novartis, Leo Pharmaceuticals, Three Rivers Pharmaceuticals, and/or Johnson & Johnson.

BOSTON – Bacteremia secondary to pneumonia caused by carbepenem-resistant Klebsiella pneumoniae carries a high mortality rate, but combination antimicrobial regimens involving polymyxins, tigecycline, or carbepenems offer a better shot at survival compared with monotherapy, according to the findings of an observational treatment study conducted at two medical centers.

Among 41 patients infected with K. pneumoniae bacteria that produce the drug-resistant Klebsiella pneumoniae Carbepenemase (KPC), 14-day mortality was 24%, and 28-day mortality was 35%, Dr. Zubair A. Qureshi reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Mortality was increased when patients received monotherapy with either colistin (4 deaths among 7 patients) or tigecycline (3 of 5 patients). However, there were no deaths within 28 days among patients treated with either colistin or tigecycline added to any carbepenem, even when the infectious organism was reported to be nonsusceptible to carbepenems, said Dr. Qureshi of the division of internal medicine at the University of Pittsburgh Medical Center.

He noted that the preliminary findings are supported by a recent review of KPC infections that documented better clinical outcomes with combination therapy compared with monotherapy (J. Antimicrob. Chemother. 2010;6:1119-25).

KPC type beta-lactamases have been shown to confer either decreased susceptibility or resistance to virtually all beta-lactam antibiotics, including the carbapenem class agents imipenem, meropenem, and ertapenem.

Investigators at the University of Pittsburgh and St. Luke’s-Roosevelt Hospital Center in New York City conducted the single-arm observational study of treatment outcomes in patients with bacteremia due to KPC-producing K. pneumoniae. Patients were screened for the presence of KPC by reduced susceptibility to ertapenem, which was confirmed with polymerase chain reaction.

The authors looked at risk factors, antimicrobial therapy, and in-hospital mortality rates. They identified 41 patients (24 women, 17 men) with KPC-producing K. pneumoniae, with a median age of 62 years (range 25-90 years). All of the cases appeared to have been acquired in either the hospital (78%) or other health care settings such as long-term care facilities. There were no identified cases of community-acquired infections.

The source of the bacteremia was vascular catheters in 29% of the cases, pneumonia in 27%, urinary tract in 15%, intra-abdominal in 4%, and superficial wounds in 4%. The source was unknown in the remaining patients.

The primary risk factor was immunocompromised status, either from a transplant, malignancy, diabetes, connective tissue disease, chronic renal failure, or HIV infection. In all, 76% of patients had recently received antimicrobial agents, and 41% were nursing-home residents.

Deaths occurred in 7 of 11 patients with pneumonia as the source of bacteremia, 3 of 12 patients with vascular catheters as the source, 1 of 6 with urinary catheter-based infections, and 3 of 12 from other or unknown sources.

When they looked at 28-day mortality in patients who received definitive therapy, they found that any combination was associated with a significantly lower rate than monotherapy (6% vs. 59%, P = .002). The analysis did not include two patients who were lost to follow-up.

The regimens consisted of various combinations of polymyxins, tigecycline, and carbapenems.

“The combination of colistin and carbepenem appears to be superior to any other antibiotic combination, but there is a need for more observation as well as randomized clinical trials to help define the optimal treatment for KPC infections,” Dr. Qureshi said.

Disclosures: Dr. Qureshi reported having no conflicts of interest. Several of his colleagues reported receiving consulting fees from AstraZeneca, Merck, Novartis, Leo Pharmaceuticals, Three Rivers Pharmaceuticals, and/or Johnson & Johnson.

BOSTON – Efforts to control hospital-acquired methicillin-resistant Staphylococcus aureus infections could be sabotaged by infectious isolates with low-level resistance to the topical anti-infectives mupirocin and chlorhexidine, according to the findings of retrospective case-control study.

Emergence of resistance and its impact should be monitored in institutions with widespread use of these agents. “Alternative agents may be required to effectively control MRSA in setting with high prevalence of resistance,” the study’s lead investigator, Dr. Andie S. Lee, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The study involved patients who underwent at least 3 days of decolonization therapy for MRSA with mupirocin and chlorhexidine, and it showed that even low-level mupirocin resistance was associated with a more than threefold increased risk of decolonization therapy failure. Chlorhexidine resistance was associated with a 10-fold increased risk, said Dr. Lee of the University of Geneva Hospitals.

Other significant risk factors identified in a multivariate analysis included prior hospitalization, age, presence of wounds or pressure sores, recent antibiotic use, and use of a central venous catheter.

She and her colleagues compared factors that might have contributed to decolonization failure among 75 MRSA carriers, compared with 75 successfully decolonized controls, matched by year of decolonization therapy.

Failed decolonization was defined as one or more positive MRSA cultures 1-12 months after decolonization. Successful decolonization was defined by six or more consecutive negative MRSA swabs with the most-recent sample within 2 years of decolonization therapy. Alternatively, if the last follow-up sample was more than 2 years after decolonization therapy, all MRSA swabs must have been negative, Dr. Lee explained at the meeting, which was sponsored by the American Society for Microbiology.

Out of a sample population of 911 patients, only 87 were successfully decolonized, and 12 of these patients were excluded by study criteria (6 for contaminated or nonviable MRSA samples and 6 for high-level mupirocin resistance of isolates) leaving 75 controls paired with 75 cases. The groups were well matched by baseline characteristics, except that more successfully decolonized patients (controls) were slightly younger (mean age 68 vs. 76 years), and had significantly shorter stays (mean 27 vs. 49 days).

The investigators found that cases were significantly more likely than were controls to have low-level resistance to mupirocin (64% vs. 35%, odds ratio 3.4), to carry the V588F mupirocin-resistance mutation (69% vs. 36%, OR 4.6), and to have low-level resistance associated with the mupA gene (24% vs. 8%, OR 5.1).

Cases also were significantly more likely than were controls to be carriers of the qacA/B efflux gene (91% vs. 68%).

In multivariate logistic regression analyses that controlled for demographic factors, comorbidities, and health care exposures, independent risk factors associated with persistent colonization with MRSA were age (OR 1.04 for every year), prior hospitalization in the past 2 years (OR 2.4), wounds/pressure sores (OR 5.7), exposure to antibiotics inactive against MRSA (OR 3.1), and use of a central venous catheter (OR 5.7).

Disclosures: The study was internally funded. Neither Dr. Lee nor her coinvestigators reported having any conflicts of interest.

BOSTON – Efforts to control hospital-acquired methicillin-resistant Staphylococcus aureus infections could be sabotaged by infectious isolates with low-level resistance to the topical anti-infectives mupirocin and chlorhexidine, according to the findings of retrospective case-control study.

Emergence of resistance and its impact should be monitored in institutions with widespread use of these agents. “Alternative agents may be required to effectively control MRSA in setting with high prevalence of resistance,” the study’s lead investigator, Dr. Andie S. Lee, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The study involved patients who underwent at least 3 days of decolonization therapy for MRSA with mupirocin and chlorhexidine, and it showed that even low-level mupirocin resistance was associated with a more than threefold increased risk of decolonization therapy failure. Chlorhexidine resistance was associated with a 10-fold increased risk, said Dr. Lee of the University of Geneva Hospitals.

Other significant risk factors identified in a multivariate analysis included prior hospitalization, age, presence of wounds or pressure sores, recent antibiotic use, and use of a central venous catheter.

She and her colleagues compared factors that might have contributed to decolonization failure among 75 MRSA carriers, compared with 75 successfully decolonized controls, matched by year of decolonization therapy.

Failed decolonization was defined as one or more positive MRSA cultures 1-12 months after decolonization. Successful decolonization was defined by six or more consecutive negative MRSA swabs with the most-recent sample within 2 years of decolonization therapy. Alternatively, if the last follow-up sample was more than 2 years after decolonization therapy, all MRSA swabs must have been negative, Dr. Lee explained at the meeting, which was sponsored by the American Society for Microbiology.

Out of a sample population of 911 patients, only 87 were successfully decolonized, and 12 of these patients were excluded by study criteria (6 for contaminated or nonviable MRSA samples and 6 for high-level mupirocin resistance of isolates) leaving 75 controls paired with 75 cases. The groups were well matched by baseline characteristics, except that more successfully decolonized patients (controls) were slightly younger (mean age 68 vs. 76 years), and had significantly shorter stays (mean 27 vs. 49 days).

The investigators found that cases were significantly more likely than were controls to have low-level resistance to mupirocin (64% vs. 35%, odds ratio 3.4), to carry the V588F mupirocin-resistance mutation (69% vs. 36%, OR 4.6), and to have low-level resistance associated with the mupA gene (24% vs. 8%, OR 5.1).

Cases also were significantly more likely than were controls to be carriers of the qacA/B efflux gene (91% vs. 68%).

In multivariate logistic regression analyses that controlled for demographic factors, comorbidities, and health care exposures, independent risk factors associated with persistent colonization with MRSA were age (OR 1.04 for every year), prior hospitalization in the past 2 years (OR 2.4), wounds/pressure sores (OR 5.7), exposure to antibiotics inactive against MRSA (OR 3.1), and use of a central venous catheter (OR 5.7).

Disclosures: The study was internally funded. Neither Dr. Lee nor her coinvestigators reported having any conflicts of interest.

BOSTON – Efforts to control hospital-acquired methicillin-resistant Staphylococcus aureus infections could be sabotaged by infectious isolates with low-level resistance to the topical anti-infectives mupirocin and chlorhexidine, according to the findings of retrospective case-control study.

Emergence of resistance and its impact should be monitored in institutions with widespread use of these agents. “Alternative agents may be required to effectively control MRSA in setting with high prevalence of resistance,” the study’s lead investigator, Dr. Andie S. Lee, said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The study involved patients who underwent at least 3 days of decolonization therapy for MRSA with mupirocin and chlorhexidine, and it showed that even low-level mupirocin resistance was associated with a more than threefold increased risk of decolonization therapy failure. Chlorhexidine resistance was associated with a 10-fold increased risk, said Dr. Lee of the University of Geneva Hospitals.

Other significant risk factors identified in a multivariate analysis included prior hospitalization, age, presence of wounds or pressure sores, recent antibiotic use, and use of a central venous catheter.

She and her colleagues compared factors that might have contributed to decolonization failure among 75 MRSA carriers, compared with 75 successfully decolonized controls, matched by year of decolonization therapy.

Failed decolonization was defined as one or more positive MRSA cultures 1-12 months after decolonization. Successful decolonization was defined by six or more consecutive negative MRSA swabs with the most-recent sample within 2 years of decolonization therapy. Alternatively, if the last follow-up sample was more than 2 years after decolonization therapy, all MRSA swabs must have been negative, Dr. Lee explained at the meeting, which was sponsored by the American Society for Microbiology.

Out of a sample population of 911 patients, only 87 were successfully decolonized, and 12 of these patients were excluded by study criteria (6 for contaminated or nonviable MRSA samples and 6 for high-level mupirocin resistance of isolates) leaving 75 controls paired with 75 cases. The groups were well matched by baseline characteristics, except that more successfully decolonized patients (controls) were slightly younger (mean age 68 vs. 76 years), and had significantly shorter stays (mean 27 vs. 49 days).

The investigators found that cases were significantly more likely than were controls to have low-level resistance to mupirocin (64% vs. 35%, odds ratio 3.4), to carry the V588F mupirocin-resistance mutation (69% vs. 36%, OR 4.6), and to have low-level resistance associated with the mupA gene (24% vs. 8%, OR 5.1).

Cases also were significantly more likely than were controls to be carriers of the qacA/B efflux gene (91% vs. 68%).

In multivariate logistic regression analyses that controlled for demographic factors, comorbidities, and health care exposures, independent risk factors associated with persistent colonization with MRSA were age (OR 1.04 for every year), prior hospitalization in the past 2 years (OR 2.4), wounds/pressure sores (OR 5.7), exposure to antibiotics inactive against MRSA (OR 3.1), and use of a central venous catheter (OR 5.7).

Disclosures: The study was internally funded. Neither Dr. Lee nor her coinvestigators reported having any conflicts of interest.

BOSTON — Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010.

They found “a strong increase in [extended-spectrum beta-lactamase–producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins — despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall's study. Dr. Denis' study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON — Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010.

They found “a strong increase in [extended-spectrum beta-lactamase–producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins — despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall's study. Dr. Denis' study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON — Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010.

They found “a strong increase in [extended-spectrum beta-lactamase–producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins — despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall's study. Dr. Denis' study was internally funded. Neither physician had conflicts of interest to disclose.

Major Finding: Adolescents with type 1 diabetes and clinically significant symptoms of depression are more likely to have higher hemoglobin A_1c values and to perform less frequent blood glucose monitoring than nondepressed adolescents with diabetes.

Data Source: Prospective 6-month study of 144 adolescents in a pediatric diabetes clinic.

Disclosures: The study was supported by a career development award to Dr. Hood. The authors reported that they had no conflicts of interest.

Depressive symptoms in adolescents with type 1 diabetes might be a marker for poor treatment compliance, a new report shows.

Adolescents with type 1 diabetes and clinically significant symptoms of depression were more likely than their nondepressed peers to have higher glycosylated hemoglobin A_1c values, and to perform less frequent daily blood glucose monitoring (BGM), Meghan E. McGrady and Dr. Korey K. Hood wrote in the journal.

The most commonly reported depressive symptoms among the 144 teens in the study included ineffectiveness and negative mood. These symptoms, linked to both hemoglobin A_1c levels at baseline and to BGM at baseline and at 6 months, might be targets for intervention, the authors wrote.

Ms. Grady and Dr. Hood, who are affiliated with the Cincinnati Children's Hospital Medical Center, looked at 144 patients, aged 13-18 years, who had been treated at the hospital's pediatric diabetes clinic. Most of the participants were white (87%), female (69%), and from households with two caregivers (76%). They were asked to fill out the 27-item Children's Depression Inventory (CDI), in which individual symptoms are rated on a scale of 0 (no symptoms) to 2 (distinct symptoms). Total scores of 13 or greater on the validated scale are deemed to be portents of clinically significant depression. The investigators correlated the symptoms scores with data on BGM frequency obtained from downloads of blood glucose meter data taken at the time of clinic visit, and with hemoglobin A_1c values measured by a standard point-of-care analyzer.

At baseline, 33 patients (23%) had CDI scores of 13 or greater (mean score for all participants: 7.92 ± 7.14). The most frequently reported symptoms were ineffectiveness (mean score 0.38 ± 0.41), negative mood (0.34 ± 0.36), anhedonia (0.32 ± 0.30), neegative self-esteem (0.24 ± 0.30), and interpersonal problems (0.15 ± 0.23).

The study, which the authors called the “first to examine the responses on CDI subscales in adolescents with type 1, had several limitations. Depressive symptoms were self-reported, and it is difficult to generalize the results to other samples because of the sociodemographic characteristics of the adolescents studied. Future studies should examine depressive symptoms over time, they said.

Major Finding: Adolescents with type 1 diabetes and clinically significant symptoms of depression are more likely to have higher hemoglobin A_1c values and to perform less frequent blood glucose monitoring than nondepressed adolescents with diabetes.

Data Source: Prospective 6-month study of 144 adolescents in a pediatric diabetes clinic.

Disclosures: The study was supported by a career development award to Dr. Hood. The authors reported that they had no conflicts of interest.

Depressive symptoms in adolescents with type 1 diabetes might be a marker for poor treatment compliance, a new report shows.

Adolescents with type 1 diabetes and clinically significant symptoms of depression were more likely than their nondepressed peers to have higher glycosylated hemoglobin A_1c values, and to perform less frequent daily blood glucose monitoring (BGM), Meghan E. McGrady and Dr. Korey K. Hood wrote in the journal.

The most commonly reported depressive symptoms among the 144 teens in the study included ineffectiveness and negative mood. These symptoms, linked to both hemoglobin A_1c levels at baseline and to BGM at baseline and at 6 months, might be targets for intervention, the authors wrote.

Ms. Grady and Dr. Hood, who are affiliated with the Cincinnati Children's Hospital Medical Center, looked at 144 patients, aged 13-18 years, who had been treated at the hospital's pediatric diabetes clinic. Most of the participants were white (87%), female (69%), and from households with two caregivers (76%). They were asked to fill out the 27-item Children's Depression Inventory (CDI), in which individual symptoms are rated on a scale of 0 (no symptoms) to 2 (distinct symptoms). Total scores of 13 or greater on the validated scale are deemed to be portents of clinically significant depression. The investigators correlated the symptoms scores with data on BGM frequency obtained from downloads of blood glucose meter data taken at the time of clinic visit, and with hemoglobin A_1c values measured by a standard point-of-care analyzer.

At baseline, 33 patients (23%) had CDI scores of 13 or greater (mean score for all participants: 7.92 ± 7.14). The most frequently reported symptoms were ineffectiveness (mean score 0.38 ± 0.41), negative mood (0.34 ± 0.36), anhedonia (0.32 ± 0.30), neegative self-esteem (0.24 ± 0.30), and interpersonal problems (0.15 ± 0.23).

The study, which the authors called the “first to examine the responses on CDI subscales in adolescents with type 1, had several limitations. Depressive symptoms were self-reported, and it is difficult to generalize the results to other samples because of the sociodemographic characteristics of the adolescents studied. Future studies should examine depressive symptoms over time, they said.

Major Finding: Adolescents with type 1 diabetes and clinically significant symptoms of depression are more likely to have higher hemoglobin A_1c values and to perform less frequent blood glucose monitoring than nondepressed adolescents with diabetes.

Data Source: Prospective 6-month study of 144 adolescents in a pediatric diabetes clinic.

Disclosures: The study was supported by a career development award to Dr. Hood. The authors reported that they had no conflicts of interest.

Depressive symptoms in adolescents with type 1 diabetes might be a marker for poor treatment compliance, a new report shows.

Adolescents with type 1 diabetes and clinically significant symptoms of depression were more likely than their nondepressed peers to have higher glycosylated hemoglobin A_1c values, and to perform less frequent daily blood glucose monitoring (BGM), Meghan E. McGrady and Dr. Korey K. Hood wrote in the journal.

The most commonly reported depressive symptoms among the 144 teens in the study included ineffectiveness and negative mood. These symptoms, linked to both hemoglobin A_1c levels at baseline and to BGM at baseline and at 6 months, might be targets for intervention, the authors wrote.

Ms. Grady and Dr. Hood, who are affiliated with the Cincinnati Children's Hospital Medical Center, looked at 144 patients, aged 13-18 years, who had been treated at the hospital's pediatric diabetes clinic. Most of the participants were white (87%), female (69%), and from households with two caregivers (76%). They were asked to fill out the 27-item Children's Depression Inventory (CDI), in which individual symptoms are rated on a scale of 0 (no symptoms) to 2 (distinct symptoms). Total scores of 13 or greater on the validated scale are deemed to be portents of clinically significant depression. The investigators correlated the symptoms scores with data on BGM frequency obtained from downloads of blood glucose meter data taken at the time of clinic visit, and with hemoglobin A_1c values measured by a standard point-of-care analyzer.

At baseline, 33 patients (23%) had CDI scores of 13 or greater (mean score for all participants: 7.92 ± 7.14). The most frequently reported symptoms were ineffectiveness (mean score 0.38 ± 0.41), negative mood (0.34 ± 0.36), anhedonia (0.32 ± 0.30), neegative self-esteem (0.24 ± 0.30), and interpersonal problems (0.15 ± 0.23).

The study, which the authors called the “first to examine the responses on CDI subscales in adolescents with type 1, had several limitations. Depressive symptoms were self-reported, and it is difficult to generalize the results to other samples because of the sociodemographic characteristics of the adolescents studied. Future studies should examine depressive symptoms over time, they said.

BOSTON – Active surveillance testing for methicillin-resistant Staphylococcus aureus colonization of pregnant women who were admitted to labor and delivery units costs a lot of bucks for only a little bang, investigators reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Over a 20-month period, a universal methicillin-resistant S. aureus (MRSA) screening program, required by Illinois law, cost $90,950 but had no apparent impact either on MRSA disease in the postpartum period or on nosocomial MRSA infections in a postpartum ward and newborn nursery, said Naseem Helo, a fourth-year medical student at Loyola University Medical Center in Maywood, Ill.

Among 2,254 pregnant women who were admitted to the labor and delivery unit, 1,819 (81%) received a nasal MRSA test at a cost of $50 each and 39 women (2%) screened positive, for a cost of more than $2,300 per positive screen, Mr. Helo said at the meeting, which was sponsored by the American Society for Microbiology.

Of the 39 MRSA-colonized women, 13 went on to have a cesarean section, 21 had vaginal delivery, 2 had miscarriages, and 3 were lost to follow-up because they did not deliver at the center.

When the investigators looked at the effect of the positive results on practice, they found that although 9 of 13 (69%) women who had cesareans had positive test results available before the surgery, only 3 of the 9 (33%) received vancomycin prophylaxis.

When they looked at the consequence of MRSA colonization for the women, they found that one had a MRSA-positive facial abscess present on admission, and one had a possible hospital-acquired case, signaled by an indurated wound that was noticed 18 days after her cesarean section, despite her having received vancomycin prophylaxis before surgery.

“During the newborn stay, no newborns had complications of MRSA disease, and there were no nosocomial infections in our labor and delivery service, postpartum ward, and newborn nursery during the 20-month study period or 2 years prior to the study,” Mr. Helo said.

The investigators suggested that the decision to implement universal MRSA surveillance should be driven by MRSA colonization rates in specific geographic populations.

The state of Illinois in 2007 passed a public act requiring every hospital to establish a MRSA control program involving identification of all high-risk MRSA patients, isolation of colonized or infected patients, monitoring and strict enforcement of hand hygiene, and maintenance of records and reporting of cases.

In October 2007, Loyola University Medical Center started screening all patients admitted to the intensive care unit with culture of anterior nares swabs, and in November of that year instituted universal screening of all admitted patients with polymerase chain reaction (PCR) testing.

For the study, the investigators reviewed microbiology data on all positive MRSA PCR screen tests and positive MRSA cultures among women who were admitted to labor and delivery and were in postpartum wards, and among infants in the newborn nursery.

Disclosures: The Loyola University Medical Center study was internally funded. Mr. Helo said he had no conflicts of interest to disclose.

BOSTON – Active surveillance testing for methicillin-resistant Staphylococcus aureus colonization of pregnant women who were admitted to labor and delivery units costs a lot of bucks for only a little bang, investigators reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Over a 20-month period, a universal methicillin-resistant S. aureus (MRSA) screening program, required by Illinois law, cost $90,950 but had no apparent impact either on MRSA disease in the postpartum period or on nosocomial MRSA infections in a postpartum ward and newborn nursery, said Naseem Helo, a fourth-year medical student at Loyola University Medical Center in Maywood, Ill.

Among 2,254 pregnant women who were admitted to the labor and delivery unit, 1,819 (81%) received a nasal MRSA test at a cost of $50 each and 39 women (2%) screened positive, for a cost of more than $2,300 per positive screen, Mr. Helo said at the meeting, which was sponsored by the American Society for Microbiology.

Of the 39 MRSA-colonized women, 13 went on to have a cesarean section, 21 had vaginal delivery, 2 had miscarriages, and 3 were lost to follow-up because they did not deliver at the center.

When the investigators looked at the effect of the positive results on practice, they found that although 9 of 13 (69%) women who had cesareans had positive test results available before the surgery, only 3 of the 9 (33%) received vancomycin prophylaxis.

When they looked at the consequence of MRSA colonization for the women, they found that one had a MRSA-positive facial abscess present on admission, and one had a possible hospital-acquired case, signaled by an indurated wound that was noticed 18 days after her cesarean section, despite her having received vancomycin prophylaxis before surgery.

“During the newborn stay, no newborns had complications of MRSA disease, and there were no nosocomial infections in our labor and delivery service, postpartum ward, and newborn nursery during the 20-month study period or 2 years prior to the study,” Mr. Helo said.

The investigators suggested that the decision to implement universal MRSA surveillance should be driven by MRSA colonization rates in specific geographic populations.

The state of Illinois in 2007 passed a public act requiring every hospital to establish a MRSA control program involving identification of all high-risk MRSA patients, isolation of colonized or infected patients, monitoring and strict enforcement of hand hygiene, and maintenance of records and reporting of cases.

In October 2007, Loyola University Medical Center started screening all patients admitted to the intensive care unit with culture of anterior nares swabs, and in November of that year instituted universal screening of all admitted patients with polymerase chain reaction (PCR) testing.

For the study, the investigators reviewed microbiology data on all positive MRSA PCR screen tests and positive MRSA cultures among women who were admitted to labor and delivery and were in postpartum wards, and among infants in the newborn nursery.

Disclosures: The Loyola University Medical Center study was internally funded. Mr. Helo said he had no conflicts of interest to disclose.

BOSTON – Active surveillance testing for methicillin-resistant Staphylococcus aureus colonization of pregnant women who were admitted to labor and delivery units costs a lot of bucks for only a little bang, investigators reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Over a 20-month period, a universal methicillin-resistant S. aureus (MRSA) screening program, required by Illinois law, cost $90,950 but had no apparent impact either on MRSA disease in the postpartum period or on nosocomial MRSA infections in a postpartum ward and newborn nursery, said Naseem Helo, a fourth-year medical student at Loyola University Medical Center in Maywood, Ill.

Among 2,254 pregnant women who were admitted to the labor and delivery unit, 1,819 (81%) received a nasal MRSA test at a cost of $50 each and 39 women (2%) screened positive, for a cost of more than $2,300 per positive screen, Mr. Helo said at the meeting, which was sponsored by the American Society for Microbiology.

Of the 39 MRSA-colonized women, 13 went on to have a cesarean section, 21 had vaginal delivery, 2 had miscarriages, and 3 were lost to follow-up because they did not deliver at the center.

When the investigators looked at the effect of the positive results on practice, they found that although 9 of 13 (69%) women who had cesareans had positive test results available before the surgery, only 3 of the 9 (33%) received vancomycin prophylaxis.

When they looked at the consequence of MRSA colonization for the women, they found that one had a MRSA-positive facial abscess present on admission, and one had a possible hospital-acquired case, signaled by an indurated wound that was noticed 18 days after her cesarean section, despite her having received vancomycin prophylaxis before surgery.

“During the newborn stay, no newborns had complications of MRSA disease, and there were no nosocomial infections in our labor and delivery service, postpartum ward, and newborn nursery during the 20-month study period or 2 years prior to the study,” Mr. Helo said.

The investigators suggested that the decision to implement universal MRSA surveillance should be driven by MRSA colonization rates in specific geographic populations.

The state of Illinois in 2007 passed a public act requiring every hospital to establish a MRSA control program involving identification of all high-risk MRSA patients, isolation of colonized or infected patients, monitoring and strict enforcement of hand hygiene, and maintenance of records and reporting of cases.

In October 2007, Loyola University Medical Center started screening all patients admitted to the intensive care unit with culture of anterior nares swabs, and in November of that year instituted universal screening of all admitted patients with polymerase chain reaction (PCR) testing.

For the study, the investigators reviewed microbiology data on all positive MRSA PCR screen tests and positive MRSA cultures among women who were admitted to labor and delivery and were in postpartum wards, and among infants in the newborn nursery.

Disclosures: The Loyola University Medical Center study was internally funded. Mr. Helo said he had no conflicts of interest to disclose.

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.

BOSTON – A nationwide coordinated infection-control plan focusing on the prevention of carbapenem-resistant Klebsiella pneumoniae infections in long-term care facilities resulted in a 50% decrease in the risk of K. pneumoniae acquisitions detected by clinical culture, Israeli investigators reported at the annual interscience conference on antimicrobial agents and chemotherapy.

The total incidence of new acquisitions detected by clinical culture declined from 5.2 per 1,000 beds in 2008 to 2.4 per 1,000 beds in 2010, a statistically significant difference. The program also reduced significantly the overall prevalence of infections in all postacute care facilities in Israel, from 12.0% in 2008 to 8.3% in 2010, said Dr. Debby Ben-David of the National Center for Infection Control in Tel Aviv.

“We found a significant burden of carbapenem-resistant K. pneumoniae carriage in postacute care facilities. A national intervention that included general upgrading of infection-control resources, in addition to specific guidelines focusing on the prevention of Klebsiella pneumonia, results in decreased rates of infection,” Dr. Ben-David said at the meeting, which was sponsored by the American Society for Microbiology.

In response to a 2006 outbreak of carbapenem-resistant K. pneumoniae (CRKP) in Israeli health care facilities, health authorities instituted an infection-control program in 2007 involving all 13 postacute care facilities (with 2,913 total beds) in the nation. The goal of the intervention was to prevent the spread of CRKP in facilities housing patients with complex medical problems who are usually transferred from acute care facilities after prolonged hospitalizations.

The target facilities care for a heterogeneous population, including patients requiring skilled nursing care, chronic mechanical ventilation, subacute care, or rehabilitation services, Dr. Ben-David noted.

The intervention consisted of mandatory weekly reports to a national coordinator, including data on transfers from other facilities, new acquisitions of CRKP (at least 72 hours after admission), screening and clinical evaluation, and total prevalence. Site visits were conducted in 2008 and 2010, and facilities were scored on 15 elements of infection control to measure compliance, she said.

Centers also performed cross-sectional prevalence surveys with representative samples of wards in each institution, collection of rectal swabs, and attention to risk factors such as skilled-nursing unit stay and sharing a room with a known CRKP carrier.

The program designers also developed and promulgated guidelines targeted to specific populations. For example, guidelines created for skilled care, ventilation, and subacute wards call for admission rectal screening, contact precautions, and single rooms or cohorting of infected patients. Guidelines for rehabilitation wards are less stringent, including modifying contact precautions and allowing room-sharing of colonized and noncolonized patients.

The investigators compared rates during two periods: January 2008 to February 2009, and March 2009 to July 2010. They found that the mean 15-point infection-control score improved from 6.7 in 2008 to 10.9 in 2010, with most of the gains being made in the areas of admissions and contact screenings, Dr. Ben-David reported.

They also looked at 1,385 patients known to be colonized with CRKP who were transferred from acute care to postacute care facilities and 846 who acquired CRKP during a postacute care stay.

The average number of transferred carriers per month did not differ significantly from 2008 (16.4 per 1,000 beds) to 2010 (17.4 per 1,000 beds), but the average number of carriers identified by active screening on admission each month nearly doubled, from 2.4 per 1,000 to 4.2 per 1,000, a significant difference.

The percentage of patients identified by screening jumped from 36.2% in 2008 to 68.9% in 2010, while the total incidence of acquisitions declined significantly, from 11.8 per 1,000 to 9.9 per 1,000.

“These results should encourage interventions in postacute care facilities to reduce the burden of antibiotic-resistant organisms,” Dr. Ben-David said.

The study was funded by the Israeli government. Neither Dr. Ben-David nor any of her coauthors had financial disclosures.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON  – The sole risk factor common to patients with bloodstream infections from either drug-resistant extended-spectrum beta-lactamase–producing strains (ESBL) of Proteus mirabilis or ESBL-negative strains was treatment with an in-dwelling catheter, a difference that might help clinicians more easily identify patients with drug-resistant infections, Italian researchers reported Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

In a retrospective, hospital-based case-control study, significant risk factors for bloodstream infections with ESBL-positive P. mirabilis were admission to a hospital from a long-term care facility, previous antibiotic therapy, indwelling urinary catheter use, and previous hospitalizations.

In contrast, the only significant risk factors associated with ESBL-negative P. mirabilis infections were immunosuppressive therapy, age over 65 years, or indwelling urinary catheter use, said Dr. Mario Tumbarello from the Policlinico Universitario Agostino Gemelli in Rome.

In the study of 89 patients with P. mirabilis sepsis treated from 1999 through 2008, ESBL positivity was associated with significantly worse outcomes. For example, among all patients with P. mirabilis bloodstream infections, the 21-day mortality rate was 31.5%. Among patients with ESBL-positive infections only, the 21-day mortality rate was 52.9%, compared with 18.2% for patients who had infections with non-ESBL strains (P =.001).

Similarly, 30-day Kaplan-Meier survival estimates were significantly better among patients with ESBL-negative infections (P = less than.001), said Dr. Tumbarello at the meeting, which was sponsored by the American Society for Microbiology.

The investigators looked back over 10 years to see whether they could identify risk factors for the isolation of ESBL-producing P. mirabilis or non-ESBL–producing P. mirabilis in blood cultures. They considered variables such as patient demographics, comorbidities, medical/surgical history, catheter use, previous immunosuppressive therapy, type, dose and duration of antibiotics, length of stay, and APACHE II score.

They found, using multivariate logistic regression analysis, that risk factors associated independently with ESBL-producing P. mirabilis bloodstream infections were admission to the hospital from a long-term care facility (odds ratio [OR] 8.68, P =.008), previous antibiotic therapy (OR 4.14, P =.003), indwelling urinary catheter (OR 3.13, P = .002), and previous hospitalization (OR, 2.76, P = 0.03).

For non-ESBL–producing isolates, independent significant risk factors were immunosuppressive therapy (OR 4.58, P =.002), age greater than 65 years (OR 4.03, P less than 0.001), and indwelling urinary catheter (OR 2.57, P = 0.01).

The study was internally funded. Dr. Tumarello said that he has no conflicts of interest relevant to the study.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.

BOSTON – Infections with dangerous strains of Escherichia coli and Klebsiella pneumoniae are on the rise in some European hospitals and communities, with potentially serious implications for infection control efforts, warned researchers Sept. 13 at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Investigators from the Netherlands mined data from a national laboratory–based surveillance system on changes in the drug susceptibility of E. coli and K. pneumoniae from 2008 through the first 6 months of 2010. They found “a strong increase in [extended-spectrum beta-lactamase-producing] E. coli in urine outside the hospital, and a strong increase in ESBL-positive K. pneumoniae in urine in hospitals,” said Dr. Maurine A. Leverstein-van Hall of the University Medical Center Utrecht, the Netherlands.

In a second study, French investigators examining the effect of bacteremias caused by ESBL-producing enterobacteria found that there was a significant increase in the prevalence of ESBL E. coli infections from 2005 to 2008.

Somewhat surprisingly, they did not see an increase in mortality rates associated with the infections, despite inadequate initial antimicrobial therapy in about half of all patients. However, that may have been due to study limitations, said Dr. Blandine Denis of St. Louis Hospital in Paris.

Dr. Leverstein-van Hall and her colleagues looked at the overall proportion of ESBL-positive isolates in the Netherlands from 2008 through 2010 in 19 labs covering one-third of all Dutch hospital beds. They found that during the study period, the proportion of ESBL-positive E. coli increased by 1.3%, and ESBL-positive K. pneumoniae rose by 1.5%.

Similarly, the proportion of ESBL-positive blood isolates increased by 1.5% and 1.7%, respectively, from 2008 through 2010. The increases in blood isolates were seen in both hospital inpatient and outpatient settings, and the increase in urine isolates were seen in general practices, long-term care facilities, and hospital inpatient and ambulatory settings.

The researchers also looked at the adequacy of empiric therapy for sepsis according to Dutch national guidelines. At least 30% of patients with sepsis received inadequate therapy, the researchers reported at the meeting, which was sponsored by the American Society for Microbiology.

The Dutch guidelines call for second- or third-generation cephalosporins or amoxicillin-clavulanic acid plus an aminoglycoside such as amikacin for sepsis of unknown origin, or an aminoglycoside combined with other agents for sepsis with a probable focus on the urogenital or digestive tracts. However, a substantial number of patients received only cephalosporins – despite the 100% resistance rate of ESBL-positive isolates to second- or third-generation agents in that class.

Empiric therapy for gram-negative sepsis should include beta-lactam/inhibitor combinations or cephalosporins, each in combination with amikacin. A switch to carbapenems could be made if culture results yield an ESBL-positive bacterial strain, Dr. Leverstein-van Hall said.

In the single-center French study, Dr. Denis and her colleagues performed a retrospective case-control analysis comparing patients with ESBL-positive bacteremia in their hospital with ESBL-negative controls matched by date. They found that slightly less than half of all ESBL-positive patients (48%) received adequate antimicrobial therapy based on the susceptibility of their respective isolates.

In an adjusted analysis of risk factors for ESBL-positive bacteremia, the French investigators found that the only statistically significant factor was previous ESBL colonization.

They also found that there were no significant differences in hospital length of stay or in 21-day mortality rates between cases and controls, although their failure to find an effect of ESBL positivity may be related to the relatively small sample size (45 cases from 2005 to 2008) and to the retrospective design, Dr. Denis acknowledged.

The Netherlands National Institute for Public Health and the Environment funded Dr. Leverstein-van Hall’s study. Dr. Denis’ study was internally funded. Neither physician had conflicts of interest to disclose.