Outcomes of carbapenem-resistant Enterobacteriaceae isolation: Matched analysis

• Published in: American journal of infection control Vol. 42; no. 6; pp. 612 - 620
• Main Authors: Bogan, Christopher, BS, Kaye, Keith S., MD, MPH, Chopra, Teena, MD, MPH, Hayakawa, Kayoko, MD, PhD, Pogue, Jason M., PharmD, Lephart, Paul R., PhD, Bheemreddy, Suchitha, MD, Lazarovitch, Tsilia, PhD, Zaidenstein, Ronit, MD, Perez, Federico, MD, Bonomo, Robert A., MD, Marchaim, Dror, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2014; Elsevier; Mosby-Year Book, Inc
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; beta-Lactam Resistance; beta-Lactamases - metabolism; Biological and medical sciences; Carbapenems - pharmacology; Case control; Case-Control Studies; Clinical outcomes; Cohort study; CRE; Critical Care; Disease control; Drug resistance; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - metabolism; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - mortality; Epidemiology. Vaccinations; Female; General aspects; Gram-negative bacteria; Hospital Mortality; Humans; Infection Control; Infectious Disease; Infectious diseases; Kaplan-Meier Estimate; KPC; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Nursing Homes; Outcome; Patient Discharge; Patients; Regression analysis; Risk Factors; Case control; Outcome; Cohort study; Risk factors; CRE; KPC; Prognosis; Check; Prevention; Infection; Risk factor; Bacteria; Isolation; Enterobacteriaceae
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2014.02.013

Background Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae , and (3) uninfected controls. Methods Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. Results Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae , and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P  = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001]. Conclusion Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity.