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    Title: Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects
    Authors: Jean, Shio-Shin
    Lee, Nan-Yao
    Tang, Hung-Jen
    Lu, Min-Chi
    Ko, Wen-Chien
    Hsueh, Po-Ren
    Contributors: Taipei Med Univ, Dept Emergency, Sch Med, Coll Med
    Taipei Med Univ, Dept Emergency Med, Wan Fang Hosp
    Taipei Med Univ, Dept Emergency & Crit Care Med, Wan Fang Hosp
    Natl Cheng Kung Univ, Dept Internal Med, Med Coll & Hosp
    Chi Mei Med Ctr, Dept Med
    Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr
    China Med Univ, Dept Microbiol & Immunol, Sch Med
    Natl Taiwan Univ, Dept Lab Med, Natl Taiwan Univ Hosp, Coll Med
    Natl Taiwan Univ, Dept Internal Med, Natl Taiwan Univ Hosp, Coll Med
    Keywords: carbapenem-resistant Enterobacteriaceae
    carbapenemase
    Klebsiella pneumoniae
    Escherichia coli
    long-term care facility
    tigecycline
    colistin
    avibactam
    Date: 2018-11-27
    Issue Date: 2019-12-16 09:35:31 (UTC+8)
    Publisher: FRONTIERS MEDIA SA
    Abstract: Carbapenem-resistant Enterobacteriaceae (CRE), a major resistance concern emerging during the last decade because of significantly compromising the efficacy of carbapenem agents, has currently become an important focus of infection control. Many investigations have shown a high association of CRE infections with high case-fatality rates. In Taiwan, a few surveys observed that a significant proportion (29-47%) of the CR-Klebsiella pneumoniae isolates harbored a plasmidic allele encoding K. pneumoniae carbapenemases (KPC, especially KPC-2). A significant increase in the number of oxacillinase (OXA)-48-like carbapenemases among CR-K. pneumoniae isolates was observed between 2012 and 2015. By striking contrast, isolates of CR-Escherichia coli and CR-Enterobacter species in Taiwan had a much lower percentage of carbapenemase production than CR-K. pneumoniae isolates. This differs from isolates found in China as well as in the India subcontinent. Apart from the hospital setting, CRE was also cultured from the inpatients from communities or long-term care facilities (LTCF). Therefore, implementation of regular CRE screening of LTCF residents, strict disinfectant use in nursing homes and hospital settings, and appropriate control of antibiotic prescriptions is suggested to alleviate the spread of clinical CRE isolates in Taiwan. Although there are some promising new antibiotics against CRE, such as ceftazidime-avibactam, meropenem-vaborbactam, aztreonam-avibactam and cefiderocol, these agents are not available in Taiwan currently. Therefore, in order to effectively decrease case-fatality rates among patients with the infections owing to carbapenemase-producing CRE isolates, combination antibiotic schemes, including colistin (or amikacin) and/or tigecycline in combination with an anti-pseudomonal carbapenem agent, remain the mainstay for treating clinical CRE infections.
    ???metadata.dc.relation.uri???: http://dx.doi.org/10.3389/fmicb.2018.02888
    Relation: Nova Hedwigia, v.9, 2888
    Appears in Collections:[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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