The Likelihood of Developing a Carbapenem-Resistant Enterobacteriaceae Infection during a Hospital Stay

Abstract

Of 1,455 unique patients in U.S. intensive care units (ICUs), 4% were rectally colonized with CRE on admission. A total of 297 patients were initially negative for carbapenem-resistant Enterobacteriaceae (CRE) and remained in the ICU long enough to contribute additional swabs; 22% of these patients had a subsequent CRE-positive swab, with a median time to CRE colonization of 13 days (interquartile range, 7 to 21 days). Patients colonized with carbapenemase-producing CRE were more likely than those colonized with non-carbapenemase-producing CRE to develop CRE infections during their hospitalizations (36% versus 3%; P Ͻ 0.05).

The Clinical and Molecular Epidemiology of Noncarbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae: A Case-Case-Control Matched Analysis

“…However, theoretically, the therapeutic challenges associated with non-CP-CRE active infection resemble those of CPE [ 41 ], and therefore the exploration of the clinical and molecular epidemiological features of non-CP-CRE, and the mode of their acquisition and spread in hospitals, is still of paramount importance. Moreover, as displayed in our cohort as well [ 21 ], some asymptomatic carriers (4%), eventually develop active infection, including BSIs.…”

“…Even the 2015 guidelines by the Centers for Disease Control and Prevention do not differentiate between the 2 entities in terms of infection control-suggested measures (although it does acknowledge the issue) [ 10 ]. As depicted in this study and by others [ 15 , 16 , 20 , 21 ], the epidemiology of non-CP-CRE differ considerably from that of CPE, and therefore measures should be tailored based of controlled analyses.…”

“…The study included 327 patients (consisting of 3 groups of 109 patients), but only 8 had acute active infection (ie, 4 with non-CP-CRE and 4 with susceptible Enterobacterales ). This might imply, as suggested by others, that current non-CP-CRE isolates display low virulence properties and reduced endemic profiles, compared with CPE isolates, but this necessitates directed controlled investigations [ 15 , 16 , 20 , 21 ]. However, theoretically, the therapeutic challenges associated with non-CP-CRE active infection resemble those of CPE [ 41 ], and therefore the exploration of the clinical and molecular epidemiological features of non-CP-CRE, and the mode of their acquisition and spread in hospitals, is still of paramount importance.…”

“…In 2 small epidemiological investigations of non-CP-CRE conducted at Johns Hopkins Hospital [ 20 , 21 ], the overall 14-day mortality of monomicrobial CPE bloodstream infections ([BSIs] n = 37) was significantly worse compared with non-CP-CRE monomicrobial BSI (n = 46) [ 20 ], and non-CP-CRE asymptomatic carriage was significantly less associated with later active infection compared with CPE [ 21 ]. These data suggest that the epidemiology of non-CP-CRE differ considerably from that of CPE, and therefore well designed and well controlled epidemiological investigations of non-CP-CRE are warranted, to curb the continued emergence of these therapeutically challenging resistant organisms.…”

Molecular Epidemiology of Carbapenemases in Enterobacteriales from Humans, Animals, Food and the Environment

“…Hospital stay represents a particularly high risk to be colonize or in developing an infection with a CRE. Recent studies found that CRE colonization among ICU patients showing new emerging mechanisms of resistance continue to rise in the United States of America [ 31 , 32 ]. There seems to have no different in other developed countries.…”