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Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study

Published online by Cambridge University Press:  10 December 2020

Jessica R. Howard-Anderson Open the ORCID record for Jessica R. Howard-Anderson [Opens in a new window] ,
Chris W. Bower ,
Gillian Smith ,
Mary Elizabeth Sexton ,
Monica M. Farley ,
Sarah W. Satola  and
Jesse T. Jacob
Jessica R. Howard-Anderson*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
Chris W. Bower
Affiliation:
Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans’ Education & Research, Decatur, Georgia
Gillian Smith
Affiliation:
Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans’ Education & Research, Decatur, Georgia
Mary Elizabeth Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Monica M. Farley
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
Sarah W. Satola
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
*
Author for correspondence: Jessica Howard-Anderson, E-mail: Jrhowa4@emory.edu
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Abstract

Objective:

To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia.

Design:

Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year.

Setting:

The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia.

Patients:

Residents of HD3 with CRE first identified in urine between 2012 and 2017.

Results:

We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8–34.9), central venous catheter (OR, 4.3; 95% CI, 1.7–10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6–11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3–25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1–7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2–23.6).

Conclusions:

In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 8 , August 2021 , pp. 962 - 967
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: A preliminary version of this work was presented at ID Week on October 3, 2019, in Washington, DC.

References

CDC. Antibiotic resistance threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2019.Google Scholar
Tacconelli, E, Magrini, N. Global priority list of antibiotic-resistant bacteria to guide research, discovery and development of new antibiotics. World Health Organization website. https://www.who.int/Medicines/Publications/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.Pdf?Ua=1. Accessed December 19, 2019.Google Scholar
Nordmann, P, Cuzon, G, Naas, T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228–236.CrossRefGoogle ScholarPubMed
Guh, AY, Bulens, SN, Mu, Y, et al. Epidemiology of carbapenem-resistant Enterobacteriaceae in 7 US communities, 2012–2013. JAMA. 2015;314:1479–1487.CrossRefGoogle ScholarPubMed
Satlin, MJ, Kubin, CJ, Blumenthal, JS, et al. Comparative effectiveness of aminoglycosides, polymyxin b, and tigecycline for clearance of carbapenem-resistant Klebsiella pneumoniae from urine. Antimicrob Agents Chemother 2011;55:5893–5899.CrossRefGoogle ScholarPubMed
Önal, U, Sipahi, OR, Pullukçu, H, et al. Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae. J Chemother 2020;32:15–20.CrossRefGoogle Scholar
Pouch, SM, Kubin, CJ, Satlin, MJ, et al. Epidemiology and outcomes of carbapenem-resistant Klebsiella pneumoniae bacteriuria in kidney transplant recipients. Transpl Infect Dis 2015;17:800–809.CrossRefGoogle ScholarPubMed
Xu, L, Sun, X, Ma, X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae . Ann Clin Microbiol Antimicrob 2017;16:2–12.CrossRefGoogle ScholarPubMed
Hauck, C, Cober, E, Richter, SS, et al. Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. Clin Microbiol Infect 2016;22:513–519.CrossRefGoogle ScholarPubMed
Qureshi, ZA, Syed, A, Clarke, LG, Doi, Y, Shields, RK. Epidemiology and clinical outcomes of patients with carbapenem-resistant Klebsiella pneumoniae bacteriuria. Antimicrob Agents Chemother 2014;58:3100–3104.CrossRefGoogle ScholarPubMed
van, Loon K, voor in’t Holt, AF, Vos, MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018;62(1):e01730–17.Google Scholar
Saint, S, Wiese, J, Amory, JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109:476–480.CrossRefGoogle ScholarPubMed
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
Standard Operating Procedure for PulseNet PFGE of Escherichia coli O157:H7, Escherichia coli non-O157 (STEC), Salmonella serotypes, Shigella sonnei and Shigella flexneri. Centers for Disease Control and Prevention website. https://www.cdc.gov/pulsenet/pdf/ecoli-shigella-salmonella-pfge-protocol-508c.pdf. Accessed November 23, 2020.Google Scholar
Sexton, ME. Evaluation of risk factors for invasive carbapenem-resistant Enterobacteriaceae infections and resultant mortality in Atlanta, 2011–2015. Master’s thesis, Emory University, Atlanta, GA; 2017.Google Scholar
Borer, A, Saidel-Odes, L, Eskira, S, et al. Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae . Am J Infect Control 2012;40:421–425.CrossRefGoogle ScholarPubMed
Schechner, V, Kotlovsky, T, Kazma, M, et al. Asymptomatic rectal carriage of blaKPC producing carbapenem-resistant Enterobacteriaceae: who is prone to become clinically infected? Clin Microbiol Infect 2013;19:451–456.CrossRefGoogle ScholarPubMed
Livorsi, DJ, Chorazy, ML, Schweizer, ML, et al. A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States. Antimicrob Resist Infect Control 2018;7(1):55.CrossRefGoogle ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle Scholar
Weiner-Lastinger, LM, Abner, S, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol 2020;41:1–18.CrossRefGoogle Scholar
Jernigan, JA, Hatfield, KM, Wolford, H, et al. Multidrug-resistant bacterial infections in US hospitalized patients, 2012–2017. N Engl J Med 2020;382:1309–1319.CrossRefGoogle Scholar
Baggs, J, Fridkin, SK, Pollack, LA, Srinivasan, A, Jernigan, JA. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med 2016;176:1639–1648.CrossRefGoogle ScholarPubMed
Logan, LK, Weinstein, RA. The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis 2017;215 suppl 1:S28–S36.CrossRefGoogle Scholar
Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae. Clin Infect Dis 2013;57:1246–1252.CrossRefGoogle ScholarPubMed
Bulger, J, Nickel, W, Messler, J, et al. Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. J Hosp Med 2013;8:486–492.CrossRefGoogle ScholarPubMed
Morgan, DJ, Croft, LD, Deloney, V, et al. Choosing wisely in healthcare epidemiology and antimicrobial stewardship. Infect Control Hosp Epidemiol 2016;37:755–760.CrossRefGoogle ScholarPubMed
de Jager, P, Chirwa, T, Naidoo, S, Perovic, O, Thomas, J. Nosocomial outbreak of New Delhi metallo-β-lactamase-1-producing gram-negative bacteria in South Africa: a case-control study. PLoS ONE 2015;10(4). doi: 10.1371/journal.pone.0123337.CrossRefGoogle Scholar
Ramos-Vivas, J, Chapartegui-González, I, Fernández-Martínez, M, et al. Biofilm formation by multidrug resistant Enterobacteriaceae strains isolated from solid organ transplant recipients. Sci Rep 2019;9:8928.CrossRefGoogle ScholarPubMed
Toth, DJA, Khader, K, Slayton, RB, et al. The potential for interventions in a long-term acute-care hospital to reduce transmission of carbapenem-resistant Enterobacteriaceae in affiliated healthcare facilities. Clin Infect Dis 2017;65:581–587.CrossRefGoogle Scholar
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