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Title: Antecedent carbapenem exposure as a risk factor for non-carbapenemase-producing carbapenem-resistant enterobacteriaceae and carbapenemase-producing enterobacteriaceae
Authors: Marimuthu, Kalisvar
Ng, Oon Tek
Cherng, Benjamin Pei Zhi
Fong, Raymond Kok Choon
Pada, Surinder Kaur
De, Partha Pratim
Ooi, Say Tat
Smitasin, Nares
Thoon, Koh Cheng
Krishnan, Prabha Unny
Ang, Michelle Lay Teng
Chan, Douglas Su Gin
Kwa, Andrea Lay Hoon
Deepak, Rama Narayana
Chan, Yu Kit
Chan, Yvonne Fu Zi
Huan, Xiaowei
Zaw Linn, Kyaw
Tee, Nancy Wen Sim
Tan, Thean Yen
Koh, Tse Hsien
Lin, Raymond Tzer Pin
Hsu, Li Yang
Sengupta, Sharmila
Paterson, David L.
Perencevich, Eli
Harbarth, Stephan
Teo, Jeanette
Venkatachalam, Indumathi
Keywords: Science::Medicine
Issue Date: 2019
Source: Marimuthu, K., Ng, O. T., Cherng, B. P. Z., Fong, R. K. C., Pada, S. K., De, P. P., . . . Venkatachalam, I. (2019). Antecedent carbapenem exposure as a risk factor for non-carbapenemase-producing carbapenem-resistant enterobacteriaceae and carbapenemase-producing enterobacteriaceae. Antimicrobial Agents and Chemotherapy, 63(10). doi:10.1128/AAC.00845-19
Journal: Antimicrobial Agents and Chemotherapy
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 blaNDM (42.8%), blaKPC (38.4%), and blaOXA-48-like (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 (blaNDM and blaKPC). 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.
ISSN: 0066-4804
DOI: 10.1128/AAC.00845-19
Rights: © 2019 American Society for Microbiology. All rights reserved. This paper was published in Antimicrobial Agents and Chemotherapy and is made available with permission of American Society for Microbiology.
Fulltext Permission: open
Fulltext Availability: With Fulltext
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