UMEM Educational Pearls

Title: Carbapenem Resistant Organisms are HERE

Keywords: Carbapenem Resistant Organisms, CRE, Pseudomonas, Infectious Diseases, Antimicrobial Stewardship (PubMed Search)

Posted: 5/15/2014 by John Greenwood, MD (Updated: 5/20/2014)
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Carbapenem Resistant Organisms are HERE

We've all heard Dr. Bryan Hayes warn us that, "Vanc & Zosyn is NOT the Answer for Everything" but things just got a little more serious, on a whole 'nother level...

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. Previously, the only reported cases were found in Europe.

It's important for EM physicians to be aware of carbapenem resistant organisms and infections because:

They have been independently associated with an increase in mortality
Are increasing in frequency around the world
Are a major threat to our antimicrobial armamentarium

Risk factors for carbapenem resistance

Stem cell transplant patients
History of mechanical ventilation
Recent ICU stay
Previous exposure to antibiotics

Antimicrobial options

Few treatment options are currently available for carbapenem resistant organisms.

Polymixins (colistimethate & polymyxin B)
Tigecycline
Fosfomycin
Some aminoglycosides (amikacin, gentamicin, & tobramycin)

Appear to have retained some in vitro activity against these organisms, but are generally used as, "drugs of last resort".

What should you do about it?

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.

References

References

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