RESUMEN
BACKGROUND: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. METHODS: Cases were defined as a US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022-15 May 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. RESULTS: We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus controls (crude matched OR, 5.0; 95% CI, 1.1-22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. Food and Drug Administration inspection of the manufacturing plant identified likely sources of contamination. CONCLUSIONS: A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers.
Asunto(s)
Proteínas Bacterianas , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Infecciones por Pseudomonas , Pseudomonas aeruginosa , beta-Lactamasas , Humanos , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/aislamiento & purificación , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/microbiología , Estudios de Casos y Controles , Masculino , Femenino , Persona de Mediana Edad , Farmacorresistencia Bacteriana Múltiple/genética , Anciano , Estados Unidos/epidemiología , Proteínas Bacterianas/genética , beta-Lactamasas/genética , Adulto , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Anciano de 80 o más Años , Pruebas de Sensibilidad Microbiana , Adulto Joven , Cefalosporinasa/genética , Cefalosporinasa/metabolismo , Carbapenémicos/farmacologíaRESUMEN
With a goal of increasing transparency regarding the utilization of Observation Units (OUs) in relation to Medicare policies, a 2012-2014 retrospective analysis was performed on 108 009 de-identified records of patients admitted from emergency departments to OUs within an urban health system. A cost-benefit analysis of OUs from the patient-centered perspective provided the theoretical patient cost. Using a query search, data regarding encounter type, length of stay, insurance carrier, origin, disposition, and age were collected. The 2016 Health Care Cost and Utilization Report was used as a means to extrapolate cost. The results showed that Medicare patients with Part B coverage were expected to pay between $516.80 to $548.20 for the average OU stay. Patients needing care in a skilled nursing facility post-OU discharge, without a 3-day qualifying stay, incurred a charge of $6244 to $6402. There is reason to investigate the policies regarding patient education and notification surrounding OUs. In an effort to improve care delivery and patient satisfaction, health care clinicians must partner with patients to improve health education and empower patients to manage their own care.