{"id":1043,"date":"2014-10-08T11:45:21","date_gmt":"2014-10-08T15:45:21","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=1043"},"modified":"2014-10-08T11:45:21","modified_gmt":"2014-10-08T15:45:21","slug":"cre-surveillance-data-from-france","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2014\/10\/08\/1043\/cre-surveillance-data-from-france\/","title":{"rendered":"CRE Surveillance Data from France"},"content":{"rendered":"

Despite all the\u00a0concern about the emergence of CRE pathogens worldwide, it is quite difficult to obtain hard quantitative, prospectively collected incidence figures.<\/p>\n

\"CarbapenemMICs\"<\/a>
R. CANTON – ISAR 2014<\/figcaption><\/figure>\n

A recent article by Robert\u00a0[1]<\/a> and colleagues provides useful data from France.\u00a0 Using a practical definition of carbapenem-non-susceptibility (ertapenem > 0.5, imipenem, meropenem > 2, doripenem > 1), they analyzed the antibiograms of > 133,000 isolates of enterobacteriaceae from 71 French laboratories between Nov. 2011 \u2013 April 2012.\u00a0\u00a0<\/p>\n

The main results were as follows:\u00a0\u00a0 0.6% of all isolates met above CRE definitions, with Enterobacter cloacae being the predominant pathogen (58%).\u00a0 Expressed differently, 8.2% of all Enterobacter cloacae isolates tested were resistant to at least 1 carbapenem.\u00a0\u00a0 There were 5.6% ESBL producers overall, and 2\/3 of all CRE were ESBL producers.<\/p>\n

Of note, resistance to carbapenem antibiotics is multifactorial and only approx. 10% of these isolates produced carbapenemase by genomic testing.\u00a0 Most were from the OXA-48 group, only 2 were NDM isolates.<\/p>\n

The authors note that their incidence figure of 0.6% for France is lower than what has been reported for Belgium (3.5%) but this may be due to methodological differences.<\/p>\n

Of course, definition for what constitutes “CRE resistance” is key here as it can affects incidence figures drastically.\u00a0 Remember, break points for carbapenem antibiotics have changed significantly in the past 2 years.\u00a0 CLSI and FDA are supposed to be in sync but are not always, and EUCAST also has definitions that are ever so slightly different from EMA.<\/p>\n

Vive la difference? \u00a0Not to worry:\u00a0 ID clinicians can handle small difference in breakpoints and live with the existing wobble of 1-2 dilution steps.\u00a0 It is actually quite amazing that the differences are so small.<\/p>\n

So let\u2019s not fuss too much over lack of harmonization: by the time harmonization occurs, the resistance situation will have changed anyway.\u00a0 Call it the microbe\u2019s revenge or the \u201cICH uncertainty principle’\u00a0\u00e0 la Heisenberg.<\/p>\n

Reference:<\/strong><\/p>\n

[1]<\/a> Robert.\u00a0 J Antimicrob Chemother 2014; 69: 2706<\/p>\n","protected":false},"excerpt":{"rendered":"

Despite all the\u00a0concern about the emergence of CRE pathogens worldwide, it is quite difficult to obtain hard quantitative, prospectively collected incidence figures. A recent article by Robert\u00a0[1] and colleagues provides useful data from France.\u00a0 Using a practical definition of carbapenem-non-susceptibility (ertapenem > 0.5, imipenem, meropenem > 2, doripenem > 1), Continue reading CRE Surveillance Data from France<\/span>→<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1047,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[227,18],"tags":[403,633,44,628,41,363,629,432,625,630,441,350,626,5,632,631,627,346],"class_list":["post-1043","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recent_literature","category-the_viewpoint","tag-antibiotic-blog","tag-belgium","tag-carbapenem","tag-carbapenemase","tag-clsi","tag-cre","tag-cre-incidence","tag-doripenem","tag-ema","tag-enterobacter","tag-ertapenem","tag-esbl","tag-eucast","tag-fda","tag-france","tag-ich","tag-imipenem","tag-meropenem"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/10\/CLSI-EUCAST-slider-copy.jpg?fit=640%2C200&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-gP","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":3100,"url":"https:\/\/allphasepharma.com\/dir\/2017\/01\/24\/3100\/kill-mocking-bug-cre-crab-variety\/","url_meta":{"origin":1043,"position":0},"title":"To Kill A Mocking Bug – of the CRKP or CRAB Variety","author":"Harald","date":"January 24, 2017","format":false,"excerpt":"Meropenem stands out as an antibiotic to be used first in ESBL and MDR infections, given its efficacy profile and safety record (see earlier blog). 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