Scientific article
English

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

Published inAntimicrobial Agents and Chemotherapy, vol. 63, no. 10
Publication date2019
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 resistance
  • Carbapenem-resistant Enterobacteriaceae
  • Carbapenemase-producing Enterobacteriaceae
  • Risk factors
Citation (ISO format)
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
Main files (1)
Article (Published version)
accessLevelRestricted
Secondary files (1)
Identifiers
Journal ISSN0066-4804
238views
0downloads

Technical informations

Creation30/10/2019 16:23:00
First validation30/10/2019 16:23:00
Update time08/10/2024 11:09:34
Status update08/10/2024 11:09:34
Last indexation31/10/2024 19:03:59
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack