Carbapenem-resistant Enterobacteriaceae (CRE) are a major threat to our vulnerable patient populations. David van Duin, MD, PhD, began studying these pathogens at the onset of the epidemic in the Great Lakes area when he and his colleagues were confronted with these essentially untreatable infections. The molecular and clinical epidemiology of these infections has been described in the context of the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1). CRACKLE is a federally funded, prospective multi-center consortium to track carbapenem-resistant Enterobacteriaceae of which Dr. van Duin is the principal investigator.
Data from CRACKLE-1 have shown that ST258 is the primary strain type of carbapenem-resistant K. pneumoniae, and that this ST258 strain type can be further subdivided into at least 2 specific clades which are distinct microbiologically and are associated with clinical outcomes. We have analyzed risk factors for and consequences of tigecycline and colistin resistance in CRE. In July 2016, with support from the Antibacterial Resistance Leadership Group (ARLG), CRACKLE-2 was started, with more than 60 hospitals worldwide participating.
Data from CRACKLE-2 have shown that CDC-defined CRE represent a diverse group of bacteria. We identified three subsets of CRE: carbapenemase-producing Enterobacterales, non-carbapenemase-producing Enterobacterales, and unconfirmed CRE, which were clinically reported as CRE but susceptible to carbapenems in subsequent laboratory testing. Unexpectedly, clinical outcomes in patients infected with any of these three CRE subsets were similar, with high mortality and readmission rates seen in all groups. Results from this study suggest that interventions to control CRE spread should extend beyond carbapenemase-producing Enterobacterales to account for high CRE diversity.
In addition, he was awarded a doctor of philosophy degree in investigative medicine from Yale University. After fellowship, he joined the Department of Infectious Diseases at the Cleveland Clinic. He was awarded the GEMSSTAR Award from the National Institute on Aging, as well as the 2012 Association of Specialty Professors-Infectious Diseases Society of America Young Investigator Award in Geriatrics. He joined the Division of Infectious Diseases at UNC in June of 2013. His main research interests are multi-drug resistant gram-negative bacteria and infections in immunocompromised patients.
Dr. van Duin and colleagues have also collaborated with the J. Craig Venter Institute.
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- van Duin D, Cober E, Richter SS, Perez F, Cline M, Kaye KS, Kalayjian RC, Salata RA, Evans S, Fowler VG, Bonomo RA. “Tigecycline Therapy for Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Bacteriuria Leads to Tigecycline Resistance.” Clinical Microbiology and Infection. 2014;20(12):O1117-20