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Title

Antecedent carbapenem exposure as a risk factor for non-carbapenemase-producing carbapenem-resistant enterobacteriaceae and carbapenemase-producing enterobacteriaceae

Authors
Ng, Oon Tek
Cherng, Benjamin Pei Zhi
Fong, Raymond Kok Choon
Pada, Surinder Kaur
De, Partha Pratim
Ooi, Say Tat
Smitasin, Nares
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Published in Antimicrobial Agents and Chemotherapy. 2019, vol. 63, no. 10
Abstract Carbapenem-resistant Enterobacteriaceae (CRE) can be mechanistically classified into carbapenemase-producing Enterobacteriaceae (CPE) and non-carbapenemase-producing carbapenem nonsusceptible Enterobacteriaceae (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 blaNDM (42.8%), blaKPC (38.4%), and blaOXA-48-like (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; P < 0.001). The odds of prior carbapenem exposure and NCPCRE detection persisted in stratified analyses by Enterobacteriaceae species (Klebsiella pneumoniae and Escherichia coli) and carbapenemase gene (blaNDM and blaKPC). CPE was associated with male gender (aOR, 1.45; 95% CI, 1.07 to 1.97; P = 0.02), intensive care unit stay (aOR, 1.84; 95% CI, 1.24 to 2.74; P = 0.003), and hospitalization in the preceding 1 year (aOR, 1.42; 95% CI, 1.01 to 2.02; P = 0.05). In a large nationwide study, antecedent carbapenem exposure was a significant risk factor for NCPCRE versus CPE, suggesting a differential effect of antibiotic selection pressure.
Keywords Carbapenem resistanceCarbapenem-resistant EnterobacteriaceaeCarbapenemase-producing EnterobacteriaceaeRisk factors
Identifiers
PMID: 31383670
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Structures
Research group Groupe Harbarth Stephan (Staphylocoques dorés résistants à la méthicilline) (866)
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MARIMUTHU, Kalisvar et al. Antecedent carbapenem exposure as a risk factor for non-carbapenemase-producing carbapenem-resistant enterobacteriaceae and carbapenemase-producing enterobacteriaceae. In: Antimicrobial Agents and Chemotherapy, 2019, vol. 63, n° 10. doi: 10.1128/AAC.00845-19 https://archive-ouverte.unige.ch/unige:132711

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Deposited on : 2020-03-20

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