Carbapenem -resistant Enterobacteriaceae (CRE) and the Imperative for Antimicrobial Stewardship. Christopher Trabue, M.D. September 13, 2013. Outline. Background and Epidemiology Clinical significance and public health implications
Christopher Trabue, M.D.
September 13, 2013
E. coli KlebsiellaEnterobacter
And the relationship therein
The rise of the New Delhi metallo-β-lactamase and other CRE
30X MIC for many bacteria
TABLE 2. Number of Enterobacteriaceaeisolates reported — United States, National Nosocomial Infections Surveillance system, National Healthcare Safety Network
CMAJ January 11, 2011 vol. 183 no. 1 59-64
Results: Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P .001) and to die from infection (38% vs 12%; P .001).
Setting: Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.
Design: Two matched case-control studies. 99 case patients, 99 controls.
Infect Control HospEpidemiol 2008; 29:1099-1106
There is hope….
Less is more….
The Tennessean Nov 2011
Not commercially available
Administrative and Community Support
Adult Inpatient Days
Relatively large number of patients, interventions, and antibiotic doses
Difficult to assign controls and comparison groups
Was observed effect truly due to our program?
Short study period