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

Carbapenem-resistant (CRE) can be mechanistically classified into carbapenemase-producing (CPE) and non-carbapenemase-producing carbapenem nonsusceptible (NCPCRE). We sought to investigate the effect of antecedent carbapenem exposure as a risk factor for NCPCRE versus CPE. Among all patients with CR...

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Published in:Antimicrobial agents and chemotherapy 2019-10, Vol.63 (10)
Main 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
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Language:English
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Summary:Carbapenem-resistant (CRE) can be mechanistically classified into carbapenemase-producing (CPE) and non-carbapenemase-producing carbapenem nonsusceptible (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 (42.8%), (38.4%), and (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;  
ISSN:0066-4804
1098-6596
DOI:10.1128/aac.00845-19