Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales : a nested case-control-control study

Article Article scientifique Article Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales : a nested case-control-control study eng 2024-09-03 author Zhou Hongyu 0000-0003-0206-1934 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 950612 author Buetti Niccolo 0000-0002-8096-1834 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Infection Antimicrobials Modeling Evolution (IAME) U 1137, INSERM, Université Paris-Cité, Paris, France. 954325 Département de médecine (DEMED) author Pérez-Galera Salvador Unidad Clínica de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain. author Bravo-Ferrer Jose Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain.,Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain. author Gutiérrez-Gutiérrez Belén 0000-0002-9668-0770 Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain.,Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. author Paniagua-García María Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain. author Feifel Jan Institute of Statistics, Ulm University, Ulm, Germany. author Sauser Julien Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 540583 author Kostyanev Tomi 0000-0002-1259-4876 Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium.,National Food Institute, Technical University of Denmark, Lyngby, Denmark. author Canton Rafael 0000-0003-1675-3173 CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain. author Tan Lionel K Research and Development, GlaxoSmithKline, London, UK. author Basoulis Dimitris First Department of Internal Medicine, Laiko General Hospital, Athens, Greece. author Pintado Vicente CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. author Roilides Emmanuel Faculty of Health Sciences, Hippokration General Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. author Dragovac Gorana Faculty of Medicine and Institute of Public Health of Vojvodina, University of Novi Sad, Novi Sad, Serbia. author Torre-Cisneros Julian CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Ciencias Médicas y Quirúrgicas, Servicio de Enfermedades Infecciosas Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Universidad de Córdoba, Córdoba, Spain. author Mediç Deana Faculty of Medicine and Institute of Public Health of Vojvodina, University of Novi Sad, Novi Sad, Serbia. author Akova Murat 0000-0002-6904-9473 Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey. author Goossens Herman Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium. author Bonten Marc Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. author Harbarth Stéphan Juergen 0000-0002-3551-1025 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 93885 Département de médecine (DEMED) author Rodriguez-Baño Jesus 0000-0001-6732-9001 Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain.,Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. author De Kraker Marlieke 0000-0003-0903-8614 Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 836719 Département de médecine (DEMED) COMBACTE- EURECA project team 2132-2141 10.1093/jac/dkae157 38988305 0305-7453 PMC11368427 https://academic.oup.com/jac/article/79/9/2132/7710869 Background: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients). Methods: A multicentre, case-control-control study was nested in a European prospective cohort study on CRE (EURECA). CRE BSI:CSE BSI matching was 1:1, CRE BSI:Uninfected patients matching was 1:3, based on hospital, ward and length of stay. Conditional logistic regression was applied. Results: From March 2016 to November 2018, 73 CRE BSIs, 73 CSE BSIs and 219 uninfected patients were included from 18 European hospitals. For CRE versus CSE BSI, previous CRE colonization/infection [incidence rate ratio (IRR) 7.32; 95% CI 1.65-32.38) increased the risk. For CRE versus uninfected controls, independent risk factors included: older age (IRR 1.03; 95% CI 1.01-1.06), patient referral (long-term care facility: IRR 7.19; 95% CI 1.51-34.24; acute care hospital: IRR 5.26; 95% CI 1.61-17.11), previous colonization/infection with other MDR organisms (MDROs) (IRR 9.71; 95% CI 2.33-40.56), haemodialysis (IRR 8.59; 95% CI 1.82-40.53), invasive procedures (IRR 5.66; 95% CI 2.11-15.16), and β-lactam/β-lactamase inhibitor combinations (IRR 3.92; 95% CI 1.68-9.13) or third/fourth generation cephalosporin (IRR 2.75; 95% CI 1.06-7.11) exposure within 3 months before enrolment. Conclusions: Evidence of previous CRE colonization/infection was a major risk factor for carbapenem resistance among Enterobacterales BSI. Compared with uninfected patients, evidence of previous MDRO colonization/infection and healthcare exposure were important risk factors for CRE BSI. Targeted screening, infection prevention and antimicrobial stewardship should focus on these high-risk patients. Humans Case-Control Studies Risk Factors Male Enterobacteriaceae Infections / epidemiology Enterobacteriaceae Infections / microbiology Female Aged Middle Aged Prospective Studies Bacteremia / microbiology Bacteremia / epidemiology Anti-Bacterial Agents / pharmacology Anti-Bacterial Agents / therapeutic use Carbapenems / pharmacology Carbapenem-Resistant Enterobacteriaceae / drug effects Carbapenem-Resistant Enterobacteriaceae / isolation & purification Europe / epidemiology Aged, 80 and over Dewey 616 European Commission Combatting Bacterial Resistance in Europe 115523 COMBACTE-NET EU FP7 European Commission Combatting Bacterial Resistance in Europe - Carbapenem Resistance 115620 COMBACTE-CARE EU FP7 Swiss National Science Foundation Epidemiology and determinants of catheter-related and hospital-acquired bloodstream infections: from a large university hospital to a global picture 194449 CH Careers 56 Département de médecine 221 false 526 Résistance aux antibiotiques 866 The journal of antimicrobial chemotherapy 79 9 4b4aa370-e974-4a36-a65f-0d62c60e068c Article (Published version) Public Article_scientifique_from_europePmc.pdf 227908 application/pdf CC BY-4.0 1e64f7cdb4f92f233539b4bbcb119ddaa3dc2ba0c213bcaffd2862d530b706d3 7b47c36e-a395-4a1a-8250-5b6db74ce9d4 Appendix Public dkae157_supplementary_data.docx 45082 application/vnd.openxmlformats-officedocument.wordprocessingml.document 8b9fdd8ddedc5b8e7e21be64f6dcf608c3a126dae25f611483fd2bd7c9fb64a3 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales : a nested case-control-control study	The journal of antimicrobial chemotherapy			2024	76	152

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Zhou, Hongyu