Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
Journal
Journal of Antimicrobial Chemotherapy
ISSN
0305-7453
1460-2091
Date Issued
2024
Author(s)
Angelique E Boutzoukas
Natalie Mackow
Abhigya Giri
Lauren Komarow
Carol Hill
Liang Chen
Yohei Doi
Michael J Satlin
Cesar Arias
Minggui Wang
Laura Mora Moreo
Erica Herc
Eric Cober
Gregory Weston
Robin Patel
Robert A Bonomo
Vance Fowler
David van Duin
Type
journal-article
Abstract
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P < 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P < 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P < 0.001].</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P < 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P < 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P < 0.001].</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.</jats:p>
</jats:sec>
Subjects
adult
;
aged
;
anti-bacterial agents
;
bacteremia
;
carbapenem-resistant enterobacteriaceae
;
community-acquired infections
;
covid-19
;
cross infection
;
enterobacteriaceae infections
;
female
;
humans
;
male
;
middle aged
;
prospective studies
;
sars-cov-2
;
avibactam plus ceftazidime
;
carbapenem
;
antiinfective agent
;
abdominal infection
;
acute disease
;
adult
;
adverse event
;
antibiotic therapy
;
article
;
australia and new zealand
;
bacterium culture
;
bloodstream infection
;
bone infection
;
carbapenem-resistant enterobacteriaceae
;
catheter infection
;
central america
;
charlson comorbidity index
;
china
;
clinical feature
;
clostridium difficile infection
;
cohort analysis
;
community acquired infection
;
comorbidity
;
controlled study
;
electronic health record
;
enterobacter aerogenes
;
enterobacter cloacae
;
enterobacteriaceae infection
;
escherichia coli
;
female
;
groups by age
;
home
;
hospice
;
hospital infection
;
hospital patient
;
hospital readmission
;
human
;
in-hospital mortality
;
infection prevention
;
infectious arthritis
;
kaplan meier method
;
kidney failure
;
klebsiella pneumoniae
;
long term care
;
major clinical study
;
male
;
medical intensive care unit
;
meningitis
;
middle east
;
mortality rate
;
outcome assessment
;
patient transport
;
pneumonia
;
probability
;
prospective study
;
sensitivity analysis
;
serratia marcescens
;
singapore
;
skin infection
;
soft tissue infection
;
south america
;
treatment outcome
;
united states
;
urogenital tract infection
;
whole genome sequencing
;
aged
;
bacteremia
;
community acquired infection
;
coronavirus disease 2019
;
cross infection
;
drug effect
;
drug therapy
;
enterobacteriaceae infection
;
epidemiology
;
microbiology
;
middle aged
;
mortality
;
severe acute respiratory syndrome coronavirus 2