Title: Carbapenem Resistant Organisms are HERE<br/>Author: John Greenwood<br/><a href='http://umem.org/profiles/faculty/412/'>[Click to email author]</a><hr/><p>
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<span style="color:#000000;"><u>Carbapenem Resistant Organisms are HERE</u></span></h3>
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We've all heard Dr. Bryan Hayes warn us that, "<a href="http://marylandccproject.org/core-content/bryan-hayes-vanc-zosyn-answer-everything/">Vanc & Zosyn is NOT the Answer for Everything</a>" but things just got a little more serious, on a whole 'nother level...</p>
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<em><strong>Within the past few months, 2 cases of NDM-producing carbapenem-resistant pseudomonas have been reported in the area - one in Delaware and one in Pennsylvania</strong>. </em> Previously, the only reported cases were found in Europe. </p>
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<span style="color:#000000;">It's important for EM physicians to be aware of carbapenem resistant organisms and infections because:</span></h3>
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They have been independently associated with an increase in mortality</li>
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Are increasing in frequency around the world</li>
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Are a major threat to our antimicrobial armamentarium</li>
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<span style="color:#000000;">Risk factors for carbapenem resistance </span></h3>
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Stem cell transplant patients</li>
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History of mechanical ventilation</li>
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Recent ICU stay</li>
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Previous exposure to antibiotics</li>
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<span style="color:#000000;">Antimicrobial options</span></h3>
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Few treatment options are currently available for carbapenem resistant organisms. </p>
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Polymixins (colistimethate & polymyxin B)</li>
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Tigecycline</li>
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Fosfomycin</li>
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Some aminoglycosides (amikacin, gentamicin, & tobramycin)</li>
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Appear to have retained some in vitro activity against these organisms, but are generally used as, "drugs of last resort". </p>
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<span style="color:#000000;">What should you do about it?</span></h3>
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<span style="color:#000000;">Know it exists, take a good history, & know your local antibiogram. Prior to selecting a broad spectrum antimicrobial regimen, try to obtain previous antimicrobial culture data for patients with resistant organism infectious risk factors.</span></p>
<fieldset><legend>References</legend>
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<u><strong>References</strong></u></div>
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<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947910/">Van duin D, Kaye KS, Neuner EA, Bonomo RA. Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes. Diagn Microbiol Infect Dis. 2013;75(2):115-20.</a></li>
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Delaware Health Alert Network: <a href="http://dhss.delaware.gov/dph/php/alerts/dhan324.html">http://dhss.delaware.gov/dph/php/alerts/dhan324.html</a></li>
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<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046948/">Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc. 2011;86(3):250-9.</a></li>
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<strong>For more critical care pearls, follow me on Twitter: <a href="https://twitter.com/johngreenwoodmd">@JohnGreenwoodMD</a></strong></p>
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