Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types

Abstract

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

Risk factors for carbapenem‐resistant Enterobacterales infection among hospitalized patients with previous colonization

“…Previous exposure to fluoroquinolones and carbapenems is independent risk factors for CRE infection 5,24 . We found that prior exposure to carbapenems was an independent risk factor for clinical CRE infection in rectal CRE carriers, which is consistent with previous study 22 . However, prior exposure to fluoroquinolones was not associated with CRE subsequent infection among rectal CRE carriers in this study.…”

“…Consistent with previous studies, the main carbapenem‐resistant bacteria in bloodstream infections among rectal carriers was K. pneumoniae (73.8% of the cases) 21 . A recent study on 702 patients suggested that carriers of carbapenemase‐producing K. pneumoniae may have an increased likelihood of prolonged carriage 22 …”

“…5,24 We found that prior exposure to carbapenems was an independent risk factor for clinical CRE infection in rectal CRE carriers, which is consistent with previous study. 22 This study has several limitations. First, this was a single-center study, which limits the generalizability of our findings.…”

“…21 A recent study on 702 patients suggested that carriers of carbapenemaseproducing K. pneumoniae may have an increased likelihood of prolonged carriage. 22 A previous Chinese study found that 37.1% of intestinal CRKP carriers developed clinical CRKP infections; additionally, ICU admission was an independent risk factor for subsequent clinical infections among intestinal CRKP carriers. 13 We observed no statistically significant difference in terms of hospitalization in the ICU.…”

“… 21 A recent study on 702 patients suggested that carriers of carbapenemase‐producing K. pneumoniae may have an increased likelihood of prolonged carriage. 22 …”