Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species

Abstract

Introduction: Risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition/ infection and associated clinical outcomes have been evaluated in the context of clonal, species-specific outbreaks. Equivalent analyses for complex, multi-species outbreaks, which are increasingly common, are lacking. Methods: Between December 2010 and January 2017, a caseecontrol study of Klebsiella pneumoniae carbapenemase (KPC)-producing organism (KPCO) acquisition was undertaken using electronic health records from inpatients in a US academic medical centre and longterm acute care hospital (LTACH) with ongoing multi-species KPCO transmission despite a robust CPE screening programme. Cases had a first KPCO-positive culture >48 h after admission, and included colonizations and infections (defined by clinical records). Controls had at least two negative perirectal screens and no positive cultures. Risk factors for KPCO acquisition, first infection following acquisition, and 14-day mortality following each episode of infection were identified using multi-variable logistic regression. Results: In 303 cases (89 with at least one infection) and 5929 controls, risk factors for KPCO acquisition included: longer inpatient stay, transfusion, complex thoracic pathology, mechanical ventilation, dialysis, and exposure to carbapenems and b-lactam/b-lactamase

Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

“…On univariate analysis, as in previous studies, [9][10][11]17,[21][22][23] we found that risk factors for both CP-CRE colonization and non-CP-CRE colonization included nursing home residency before hospital admission, antibiotic treatment 3 months before admission, urinary catheter, decubitus ulcer, and mechanical ventilation. We did not find men to be at an increased risk for CP-CRE or non-CP-CRE colonization in comparison to other studies, 9,10 which may have been due to an older patient population in our study and the longer life expectancy of women in Israel.…”

“…CRE resistance can be divided into 2 major groups: CP-CRE and non-CP-CRE. Previous studies [9][10][11][12][17][18][19][20][21][22][23][24] have addressed the issue of risk factors for CRE colonization/infection as a whole (ie, 1 group), showing that the following factors were associated with CRE acquisition: male sex, nursing home residency before hospital admission, history of admission within 1 year, poor functional status, Charlson index score ≥3, urinary catheter, decubitus ulcer, mechanical ventilation, intensive care unit stay, undergoing an invasive procedure with a scope device, and prior antibiotic exposure including penicillins, cephalosporins, carbapenems, vancomycin and fluoroquinolones.…”

“…A study by Dautzenberg et al 16 showed that patients colonized with CP-CRE have a higher hazard of dying in the intensive care unit (ICU) than noncolonized patients. Mathers et al 17 found that healthcare exposures, antimicrobials, and invasive procedures increased the risk of Klebsiella pneumonia CP colonization or infection. 17 To the best of our knowledge, no studies have compared the risk factors and outcomes between patients colonized with one of the CRE groups, comparing CP-CRE-colonized and non-CP-CREcolonized patients.…”

“…Mathers et al 17 found that healthcare exposures, antimicrobials, and invasive procedures increased the risk of Klebsiella pneumonia CP colonization or infection. 17 To the best of our knowledge, no studies have compared the risk factors and outcomes between patients colonized with one of the CRE groups, comparing CP-CRE-colonized and non-CP-CREcolonized patients. In the present work, we address these issues.…”

Molecular Characterization of Carbapenemase-Producing Escherichia coli and Salmonella in children with diarrhea in rural Burkina Faso

“…This phenomenon also contributes to the global spread of Carbapenemase-producing bacteria becoming therefore especially worrisome [20]. It has been shown that Enterobacterales spp., such as Escherichia coli and Klebsiella pneumoniae, are common human pathogens and asymptomatic colonizers of the human gastrointestinal tract and environmental niches [21]. Our study reported for the rst time the occurrence of Carbapenemase-producing E. coli and Salmonella in children with diarrhea in rural settings of Burkina Faso.…”