Carbapenem-resistant Enterobacteriaceae: Prevalence, Risk Factors and Impact of the Use of the Phenotypic Algorithm for the Detection of Carbapenemases (E-CARB)

The non-susceptibility of enterobacteriaceae isolates to carbapenem (CARBA) is an emerging concern with a high impact on infectious disease therapy. carbapenemase (CARBase) production are one of the mechanisms of resistance to CARBA. When CARBase production is suspected or proved, specific hygiene measures have to be applied in any hospital. Detecting CARBase in the routine in any laboratory is difficult. it will be useful to standardize them detection to control the emergence.

Study Overview

• Status: Completed
• Conditions: Enterobacteria Non Susceptible to Carbapenem Carrier; Enterobacteria Susceptible to Carbapenem Carrier

Detailed Description

The non-susceptibility of enterobacteriaceae isolates to carbapenem (CARBA) is an emerging concern with a high impact on infectious disease therapy because CARBA are often the alone antibiotics available to cure severe infections due to extended-spectrum β-lactamase (ESBL)-producing isolates. Two mechanisms of resistance to CARBA have been identified: membrane impermeability associated with ESBL or cephalosporinase production and carbapenemase (CARBase) production. When CARBase production is suspected or proved, specific hygiene measures have to be applied in any hospital in order to avoid the dissemination of the CARBase-producing strain and insure patient safety. Prevalence rate of non-susceptible (NS) isolates to CARB, the proportion of the two types of mechanisms of resistance to CARB and the factors associated with CARB- NS isolates are still unknown in France. Moreover, detecting CARBase in the routine in any laboratory is difficult. Providing data regarding all of these points will be useful for any hospital and will permit to optimize the management of the patients suspected or proved to harbor a CARBase-producing Enterobacteriaceae isolate.

• Study Type: Observational
• Enrollment (Actual): 525

Contacts and Locations

Study Locations

• France
  • Clichy, France, 92110
    • Hôpital Beaujon

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

• Patient hospitalised for more than 24 hours , with a clinical sample positive for a NS-CARB Enterobacteriaceae
• Patient hospitalised for more than 24 hours with clinical sample positive for a non-NS-CARB Enterobacteriaceae and hospitalised in the same type of ward as that case
• Patient hospitalised for more than 24 hours having had clinical sample(s) being stayed negative since the beginning of his admission and up to 3 days after the detection of the case, hospitalised in any type of ward in the hospital

Description

Inclusion Criteria:

• Case: Patient with a clinical sample positive for a NS-CARB Enterobacteriaceae
• Control 1: Patient with clinical sample positive for a non-NS-CARB Enterobacteriaceae and hospitalised in the same type of ward as that case
• Control 2: Patient having had clinical sample(s) being stayed negative since the beginning of his admission and up to 3 days after the detection of the case, hospitalised in any type of ward in the hospital

Exclusion Criteria:

• the patient with digestive ER-CARB

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Case: NS-CARB positive; Patient with a clinical sample positive for a NS-CARB Enterobacteriaceae
Control 1: non-NS-CARB positive; Patient with clinical sample positive for a non-NS-CARB Enterobacteriaceae
Control 2 : negative sample; Patient having had clinical sample(s) being stayed negative since the beginning of his admission and up to 3 days after the detection of the case

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of CARB-NS isolates and among them the proportion of those producing CARBase.	Determining the prevalence rate of CARB-NS isolates and among them the proportion of those producing CARBase for all enterobacterial species and for each species. CARBase production will be determined by using in a phenotypic algorithm previously established on the basis on commercialized tests and by molecular methods. Determining by using a prospective case-control-control study the factors associated with a clinical sample positive for a NS-CARB isolate by distinguishing isolates non-CARBase-producing and isolates CARBase-producing.This study will be carried out during one year in 18 hospitals across France whose laboratory will participate in the prevalence study. The variables independently associated with a clinical sample positive for either a NS-CARB, non-CARBase-producing isolate or a NS-CARB, CARBase-producing isolate will be determined in a multivariate analysis.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Detection of CARBase producing isolates as a measure of the diagnostic value of the phenotypic algorithm	Assessing the diagnostic value (sensitivity, specificity, positive predictive value and negative predictive value) of the phenotypic algorithm for the detection CARBase producing isolates by using the molecular methods as Gold standard method	1 year
Impact of the use of the phenotypic algorithm on the management of the patients identified as carrier of NS-CARB isolate.	Assessing the impact of the use of the phenotypic algorithm on the management of the patients identified as carrier of NS-CARB isolate (case) in the 18 hospitals : (i) time between the period at which the isolate is identified as NS-CARB and, on the one hand, knowledge acquisition by the Hygiene team and the medical staff of the presence of the case, and on the other hand, the period at which barrier precautions are implemented by distinguishing the type of barrier precautions implemented (standard or with dedicated non-medical staff) (ii) the duration of the implementation of barrier precaution with regard to the results concerning the production or the non-production of a CARBase by the NS-CARB isolate . The results of this study will be compared with the results obtained during a previous study in which the phenotypic algorithm had not been used.	1 year

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris
• Investigators: Principal Investigator: Marie-Hélène Nicolas-Chanoine, MD, PhD, Assistance Publique - Hôpitaux de Paris

Study record dates

Study Major Dates

• Study Start: May 1, 2014
• Primary Completion (Actual): May 1, 2016
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: April 16, 2014
• First Submitted That Met QC Criteria: April 28, 2014
• First Posted (Estimate): April 30, 2014

Study Record Updates

• Last Update Posted (Estimate): November 28, 2016
• Last Update Submitted That Met QC Criteria: November 24, 2016
• Last Verified: November 1, 2016

More Information

Terms related to this study

• Keywords: prevalence; Enterobacteriaceae; screening algorithm; non-susceptible to carbapenem; carbapenemases
• Other Study ID Numbers: NI 12025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED