eprintid: 37822
rev_number: 22
userid: 9247
dir: disk0/00/03/78/22
datestamp: 2020-08-20 18:36:25
lastmod: 2020-08-20 18:36:25
status_changed: 2020-08-20 18:36:25
type: thesis
metadata_visibility: show
contact_email: atwhaley17@gmail.com
eprint_status: archive
creators_name: Whaley, Andrew
creators_email: atw34@pitt.edu
contributors_type: committee_chair
contributors_type: committee_member
contributors_name: Martinson, Jeremy
contributors_name: Haggerty, Catherine
contributors_email: jmartins@pitt.edu
contributors_email: haggerty@pitt.edu
title: Carbapenem resistance: a retrospective review of the literature and clinical data
ispublished: unpub
divisions: sch_gsph_infectiousdiseasesmicrobiology
full_text_status: public
abstract: Carbapenem resistance has emerged as one of the most urgent threats of the 21st century. Over the last 50 years there has been an increase in the resistance towards carbapenems, a last resort antibiotic known for its broad-spectrum ability to treat bacterial infections. Factors contributing to this increase include various biological and behavioral factors such as mutations among bacteria, presence of efflux pumps, and carbapenemases as well as the over prescription and misuse of antibiotics. Due to these increases we investigated carbapenem resistance at a tertiary care facility in Pittsburgh, PA as well as conducted a literature review on the epidemiology, public health impact, and mechanisms of resistance in the hopes of presenting various directions of future research on both the local and national level.

A retrospective chart review was conducted using TheraDoc® and Cerner PowerChart® to evaluate carbapenem resistant among patients at UPMC Mercy Hospital. We reviewed data between 2013 and 2019 for cases of carbapenem resistance. The five most common carbapenem resistant organisms (CROs) according to the literature were included in the study; Enterobacter sp., Klebsiella sp., E. coli, Acinetobacter sp., and Pseudomonas sp. The index culture of each patient was included; patients were reincluded as separate records if an infection appeared after 90 days of the index case and if the isolate was tested for resistance to multiple carbapenems. Microbiology results were determined by using MIC breakpoints set by the CLSI. Patient location, source of infection, and case reoccurrences were also investigated.
	
Results showed that 95.9% of intermediate or resistant cases were resistant to at least one carbapenem over the time period of the study. Furthermore, an upward trend between 2013-2015 followed by a downward trend between 2016-2019 was noticed. Acinetobacter sp. accounted for 50.9% of infections followed by Klebsiella sp. at 32.5%, and Enterobacter sp. at 9.9%. The most common location where infections occurred were inpatient units followed by the ICU; 37.6% and 34.3 respectively. Urinary tract infections accounted for the 35.1% of cases while respiratory accounted for 23.2%. Recurrent infections were caused commonly caused by Acinetobacter sp. This study revealed vital information regarding carbapenem resistance at UPMC Mercy Hospital. These data show the number of CRO cases, yearly trends, common sites of acquisition and patient locations, as well as the breakdown for case reoccurrences. Overall, this literature review and these data suggest that further research should be pursued in order to understand potential risk factors for CRO infections and improve antimicrobial stewardship.
date: 2019-12-04
date_type: submitted
pages: 58
institution: University of Pittsburgh
refereed: TRUE
thesis_type: masteressay
degree: MPH
citation:   Whaley, Andrew  (2019) Carbapenem resistance: a retrospective review of the literature and clinical data.  Master Essay, University of Pittsburgh.   
document_url: http://d-scholarship-dev.library.pitt.edu/37822/1/WhaleyAndrew_MPHEssay_December2019.docx