Characteristics of community-acquired carbapenem-resistant Enterobacterales
Author:
Shrestha Rima1, Luterbach Courtney L12, Dai Weixiao3, Komarow Lauren3, Earley Michelle3, Weston Gregory4, Herc Erica5, Jacob Jesse T67, Salata Robert8, Wong Darren9, Anderson Deverick1011, Rydell Kirsten B12, Arias Cesar A1213, Chen Liang1415, van Duin David1ORCID, Weston Gregory, Ostrowsky Belinda, Lok Judith J, Bonomo Robert A, Domitrovic T Nicholas, Hujer Kristine M, Hujer Andrea M, Rudin Susan D, Marshall Steven H, Salata Robert A, Perez Federico, Cober Eric, Richter Sandra S, Arias Rebekka, Hill Carol, Fowler Vance G, Anderson Deverick J, Jacob Jesse T, Wang Minggui, Chen Liang, Desai Samit, Kreiswirth Barry N, Manca Claudia, Mediavilla Jose R, Patel Gopi, Huskins W Charles, Patel Robin, Revolinski Sara, Wortmann Glenn, Kalayjian Robert C, Kim Angela, Garcia-Diaz Julia, Fries Bettina C, Eilertson Brandon, Gallagher Jason C, Earley Michelle, Evans Scott, Komarow Lauren, Garner Omai B, Chambers Henry F, Farrell John J, Abbo Lilian M, Kaye Keith S, Luterbach Courtney, van Duin David, Han Jennifer H, Doi Yohei, Paterson David L, Wong Darren, Arias Cesar A, Hanson Blake, Dinh An, Panesso Diana, Shropshire William, Tran Truc T, Banerjee Ritu, Dhar Sorabh, Satlin Michael J, Grant Matthew,
Affiliation:
1. Division of Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina , USA 2. Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina , Chapel Hill, North Carolina , USA 3. The Biostatistics Center, The George Washington University , Rockville, Maryland , USA 4. Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx , New York , USA 5. Division of Infectious Diseases, Department of Medicine, Henry Ford Hospital , Detroit, Michigan , USA 6. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA 7. Emory Antibiotic Resistance Center , Atlanta, Georgia , USA 8. Department of Medicine, Case Western Reserve University School of Medicine , Cleveland, Ohio , USA 9. Keck School of Medicine, University of Southern California , Los Angeles, California , USA 10. Division of Infectious Diseases, Duke University, School of Medicine , Durham, North Carolina , USA 11. Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA 12. Division of Infectious Diseases, Houston Methodist Hospital , Houston, Texas , USA 13. Center for Infectious Diseases Research at Houston Methodist Research Institute and Weill Cornell Medical College , Houston, Texas , USA 14. Center for Discovery and Innovation, Hackensack Meridian Health , Nutley, New Jersey , USA 15. Department of Medical Sciences, Hackensack Meridian School of Medicine , Nutley, New Jersey , USA
Abstract
Abstract
Background
Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat.
Methods
In CRACKLE-2, we defined patients with CA-CRE as admitted from home, without pre-existing conditions, and a positive culture within 48 h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community acquisition, not admitted from home and cultured >48 h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling.
Results
CA-CRE and HA-CRE were detected in 83 (10%) and 208 (26%) of 807 patients. No significant differences were observed in bacterial species or strain type distribution. K. pneumoniae (204/291, 70%) was the most common CRE species, of these 184/204 (90%) were carbapenemase producers (CPKP). The top three genetic markers in random forest models were kpi_SA15, fimE, and kpfC. Of these, kpi_SA15 (which encodes a chaperone/usher system) was positively associated (OR 3.14, 95% CI 1.13–8.87, P = 0.026), and kpfC negatively associated (OR 0.21, 95% CI 0.05–0.72, P = 0.015) with CA-CPKP.
Conclusions
Ten percent of CDC-defined CRE were CA. The true proportion of CA-CRE in hospitalized patients is likely lower as patients may have had unrecorded prior healthcare exposure. The kpi_SA15 operon was associated with the CA phenotype.
Funder
National Institute of Allergy and Infectious Diseases National Institutes of Health National Institute of General Medical Sciences
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)
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