Poor outcomes in both infection and colonization with carbapenem-resistant Enterobacterales

• Type of Material: Article
• Authors: Jessica Howard-Anderson, Emory University; Michelle Earley, George Washington University; Lauren Komarow, George Washington University; Lilian Abbo, University of Miami; Deverick J Anderson, Duke University; Jason C Gallagher, Temple University; Matthew Grant, Yale School of Medicine; Angela Kim, Northwell Health, Manhasset; Robert A Bonomo, Louis Stokes Cleveland Department of Veterans’ Affairs Medical; David van Duin, University of North Carolina; Silvia Munoz-Price, Medical College of Wisconsin; Jesse Jacob, Emory University
• Language: English
• Date: 2022-02-02
• Publisher: CAMBRIDGE UNIV PRESS
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/ice.2022.4
• Title of Journal or Parent Work: INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
• Volume: 43
• Issue: 12
• Start Page: 1840
• End Page: 1846
• Grant/Funding Information: J.H.A. was supported by the Antibacterial Resistance Leadership Group fellowship of National Institute of Allergy and Infectious Disease (grant no. UM1AI104681).; This research was also supported by the National Institutes of Health (grant nos. R01AI100560, R01AI063517 and R01AI072219 to R.A.B.) and in part by funds and/or facilities provided by the Cleveland Department of Veterans’ Affairs (award no. 1I01BX001974 to R.A.B. from the Biomedical Laboratory Research & Development Service of the VA Office of Research and Development and the Geriatric Research Education and Clinical Center VISN 10 to R.A.B).; Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (grant no. UM1AI104681).
• Keywords: RISK; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; Infectious Diseases; EPIDEMIOLOGY; MORTALITY; Science & Technology
• Research Categories: Health Sciences, Pharmacology

Abstract

Objectives: To describe the epidemiology of patients with nonintestinal carbapenem-resistant Enterobacterales (CRE) colonization and to compare clinical outcomes of these patients to those with CRE infection. Design: A secondary analysis of Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae 2 (CRACKLE-2), a prospective observational cohort. Setting: A total of 49 US short-term acute-care hospitals. Patients: Patients hospitalized with CRE isolated from clinical cultures, April, 30, 2016, through August 31, 2017. Methods: We described characteristics of patients in CRACKLE-2 with nonintestinal CRE colonization and assessed the impact of site of colonization on clinical outcomes. We then compared outcomes of patients defined as having nonintestinal CRE colonization to all those defined as having infection. The primary outcome was a desirability of outcome ranking (DOOR) at 30 days. Secondary outcomes were 30-day mortality and 90-day readmission. Results: Of 547 patients with nonintestinal CRE colonization, 275 (50%) were from the urinary tract, 201 (37%) were from the respiratory tract, and 71 (13%) were from a wound. Patients with urinary tract colonization were more likely to have a more desirable clinical outcome at 30 days than those with respiratory tract colonization, with a DOOR probability of better outcome of 61% (95% confidence interval [CI], 53%-71%). When compared to 255 patients with CRE infection, patients with CRE colonization had a similar overall clinical outcome, as well as 30-day mortality and 90-day readmission rates when analyzed in aggregate or by culture site. Sensitivity analyses demonstrated similar results using different definitions of infection. Conclusions: Patients with nonintestinal CRE colonization had outcomes similar to those with CRE infection. Clinical outcomes may be influenced more by culture site than classification as "colonized"or "infected."