Multidrug Resistant-Enterobacteriaceae Isolated From Inpatients in North America: TEST 2011–2014
Why this work is in the frame
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Bibliographic record
Abstract
Background. Multidrug-resistant (MDR) Enterobacteriaceae pose serious challenges for patient treatment and infection control. Using data from the Tigecycline Evaluation and Surveillance Trial (TEST), the epidemiology and susceptibility of MDR Enterobacteriaceae from North America were examined. Methods. 9316 Enterobacteriaceae isolates (Escherichia coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., and Serratia spp.) from various specimen sources were collected in Canada and United States (US) from inpatients in 2011-2014. MICs were determined at each site using CLSI broth microdilution method and interpreted according to CLSI guidelines. Isolates were categorized as multi-drug resistant if resistant to ≥3 of the tested drug classes (glycylcyclines, β-lactam/inhibitor, cephems, penems, penicillins [ampicillin], quinolones, tetracyclines, and aminoglycosides). Results. The overall MDR rate for Enterobacteriaceae in 2011-2014 in North America was 19.1%. MDR rates for selected species are shown below. The relatively high MDR rate for E. coli was at least in part due to high levofloxacin resistance of 31% in this species. MDR rates for all Enterobacteriaceae for the years 2011-2014 were 19.7%, 20.1%, 18.8%, and 17.5% (p = 0.04, Cochran-Armitage test for trend). The overall MDR rate for 2011-2014 was 22.0% in Canada versus 18.6% in the United States; 21.5% in ICU wards versus 18.3% in non-ICU wards; and 19.6% in medicine wards versus 18.9% in surgery wards. Susceptibility of MDR pathogens in 2014 was ≤21% to ampicillin, amoxicillin-clavulanate, and ceftriaxone; 50-70% to cefepime, levofloxacin, piperacillin-tazobactam, and minocycline; and >90% to amikacin, meropenem, and tigecycline. Conclusion. Almost 20% of Enterobacteriaceae were MDR in North America in 2011-2014, although the prevalence appears to be slightly decreasing. MDR rates for Enterobacteriaceae varied by species but overall were fairly similar in United States and Canada as well as across types of wards. Treatment of these isolates is challenging with only amikacin, meropenem, and tigecycline inhibiting >90% in 2014. Disclosures. S. Lob, IHMA, Inc: Independent Contractor, Consulting fee; D. Biedenbach, IHMA, Inc: Independent Contractor, Consulting fee; M. Hackel, IHMA, Inc: Independent Contractor, Consulting fee; D. Sahm, IHMA, Inc: Independent Contractor, Consulting fee; H. Leister-Tebbe, Pfizer, Inc: Employee, Salary
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it