Post-surgical mediastinitis due to carbapenem-resistantEnterobacteriaceae: Clinical, epidemiological and survivalcharacteristics

Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE),including polymyxin-resistant(PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE,including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE(PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carriedblaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received atleast one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higherin patients infected with PR-CRE (17% vs. 53%; P = 0.06). In conclusion, mediastinitis due to CRE, includingPR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a highmortality, particularly those infected with PR-CRE...

Carbapenem-resistant Enterobacteriaceae on a cardiacsurgery intensive care unit: successful measures for infection control

Carbapenem-resistant Enterobacteriaceae (CRE) cause surgical site infections(SSIs) in intensive care units (ICUs). This study aimed to evaluate the impact of intervention and control measures to reduce CRE colonization and infection rates among patients in the ICU of a cardiac surgery hospital following a CRE outbreak...