Back to Search Start Over

Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenemase-Producing Enterobacteriaceae.

Authors :
Marimuthu K
Ng OT
Cherng BPZ
Fong RKC
Pada SK
De PP
Ooi ST
Smitasin N
Thoon KC
Krishnan PU
Ang MLT
Chan DSG
Kwa ALH
Deepak RN
Chan YK
Chan YFZ
Huan X
Zaw Linn K
Tee NWS
Tan TY
Koh TH
Lin RTP
Hsu LY
Sengupta S
Paterson DL
Perencevich E
Harbarth S
Teo J
Venkatachalam I
Source :
Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2019 Sep 23; Vol. 63 (10). Date of Electronic Publication: 2019 Sep 23 (Print Publication: 2019).
Publication Year :
2019

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) can be mechanistically classified into carbapenemase-producing Enterobacteriaceae (CPE) and non-carbapenemase-producing carbapenem nonsusceptible Enterobacteriaceae (NCPCRE). We sought to investigate the effect of antecedent carbapenem exposure as a risk factor for NCPCRE versus CPE. Among all patients with CRE colonization and infection, we conducted a case-control study comparing patients with NCPCRE (cases) and patients with CPE (controls). The presence of carbapenemases was investigated with phenotypic tests followed by PCR for predominant carbapenemase genes. We included 843 unique patients with first-episode CRE, including 387 (45.9%) NCPCRE and 456 (54.1%) CPE. The resistance genes detected in CPEs were bla <subscript>NDM</subscript> (42.8%), bla <subscript>KPC</subscript> (38.4%), and bla <subscript>OXA-48-like</subscript> (12.1%). After adjusting for confounders and clustering at the institutional level, the odds of prior 30-day carbapenem exposure was three times higher among NCPCRE than CPE patients (adjusted odds ratio [aOR], 3.48; 95% confidence interval [CI], 2.39 to 5.09; P  < 0.001). The odds of prior carbapenem exposure and NCPCRE detection persisted in stratified analyses by Enterobacteriaceae species ( Klebsiella pneumoniae and Escherichia coli ) and carbapenemase gene ( bla <subscript>NDM</subscript> and bla <subscript>KPC</subscript> ). CPE was associated with male gender (aOR, 1.45; 95% CI, 1.07 to 1.97; P  = 0.02), intensive care unit stay (aOR, 1.84; 95% CI, 1.24 to 2.74; P  = 0.003), and hospitalization in the preceding 1 year (aOR, 1.42; 95% CI, 1.01 to 2.02; P  = 0.05). In a large nationwide study, antecedent carbapenem exposure was a significant risk factor for NCPCRE versus CPE, suggesting a differential effect of antibiotic selection pressure.<br /> (Copyright © 2019 American Society for Microbiology.)

Details

Language :
English
ISSN :
1098-6596
Volume :
63
Issue :
10
Database :
MEDLINE
Journal :
Antimicrobial agents and chemotherapy
Publication Type :
Academic Journal
Accession number :
31383670
Full Text :
https://doi.org/10.1128/AAC.00845-19