Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

Abstract

Summary Background Carbapenemase-producing organisms (CPO) have been largely responsible for the extensive spread of carbapenem resistance, and their prevalence is increasing in many parts of the world. Aim To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients. Methods All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003–2017 were reviewed retrospectively. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalized linear mixed model was used to identify risk factors for mortality. Findings In total, 290 individuals with CPO were identified. The overall incidence increased over time ( P <0.001) from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%), and Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) were the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211), while the case fatality rate was 5.7% (12/211). Age >60 years [adjusted odds ratio (aOR) 3.36, 95% confidence interval (CI) 1.06–10.63; P =0.033], presence of non-fermenters (aOR 4.88, 95% CI 1.64–14.47; P =0.005), and systemic infection or organ failure (aOR 4.21, 95% CI 1.38–12.81; P =0.032) were independently associated with 30-day mortality. Conclusion The incidence of CPO in Scotland is low but increasing. Awareness is required that inpatients aged >60 years, patients with systemic infection or organ failure, and patients presenting with non-fermenters are at higher risk of death from CPO.

Genomic investigation of multi-species and multi-variant blaNDM outbreak reveals key role of horizontal IncN and IncX3 plasmid transfer

“…Ultimately 29% patients developed NDM infection and the 30-day crude mortality rate among these patients was 14%, consistent with previously reported mortality rates of ~10-20% [17,18]. Our study also underscored the challenges of outbreak detection when horizontal transmission of plasmids is the primary mode of spread, particularly due to the remarkable plasticity of plasmids, which can undergo substantial changes even within a single patient [19].…”

Genomic investigation of multispecies and multivariant blaNDM outbreak reveals key role of horizontal plasmid transmission

“…Ultimately, 29% patients developed NDM infection and the 30-day crude mortality rate among these patients was 14%, consistent with previously reported mortality rates of ∼10%-20%. 22,23 Our findings also underscore the challenges of outbreak detection when horizontal transmission of plasmids is the primary mode of spread, particularly due to the remarkable plasticity of plasmids, which can undergo substantial changes even within a single patient. 24 We noted significant shifts in NDM epidemiology during the study.…”

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017–2021

“…While the number of CPE infections increased from 2017 to 2021 in the CNISP network, incidence remained stable from 2018 to 2021. Data on the incidence of CPE infections in other countries, such as the United Kingdom, have noted increasing incidence of CPE infections (( 52 , 53 )). Similarly, the number of CPE isolates identified through laboratory surveillance associated with CPE infections has increased in Switzerland from 2013 to 2018 (( 54 )).…”