Journal article
Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenemase-Producing Enterobacteriaceae
Antimicrobial agents and chemotherapy, Vol.63(10)
10/2019
DOI: 10.1128/aac.00845-19
PMCID: PMC6761519
PMID: 31383670
Abstract
Carbapenem-resistant
(CRE) can be mechanistically classified into carbapenemase-producing
(CPE) and non-carbapenemase-producing carbapenem nonsusceptible
(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
(42.8%),
(38.4%), and
(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;
< 0.001). The odds of prior carbapenem exposure and NCPCRE detection persisted in stratified analyses by
species (
and
) and carbapenemase gene (
and
). CPE was associated with male gender (aOR, 1.45; 95% CI, 1.07 to 1.97;
= 0.02), intensive care unit stay (aOR, 1.84; 95% CI, 1.24 to 2.74;
= 0.003), and hospitalization in the preceding 1 year (aOR, 1.42; 95% CI, 1.01 to 2.02;
= 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.
Details
- Title: Subtitle
- Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenemase-Producing Enterobacteriaceae
- Creators
- Kalisvar Marimuthu - Yong Loo Lin School of Medicine, National University of Singapore, SingaporeOon Tek Ng - Lee Kong Chian School of Medicine, Nanyang Technological University, SingaporeBenjamin Pei Zhi Cherng - DUKE-NUS Medical School, National University of Singapore, SingaporeRaymond Kok Choon Fong - Department of Infectious Diseases, Changi General Hospital, SingaporeSurinder Kaur Pada - Department of Infectious Diseases, Ng Teng Fong General Hospital, SingaporePartha Pratim De - Department of Laboratory Medicine, Tan Tock Seng Hospital, SingaporeSay Tat Ooi - Division of Infectious Diseases, Department of General Medicine, Khoo Teck Puat Hospital, SingaporeNares Smitasin - Division of Infectious Disease, University Medicine Cluster, National University Hospital, SingaporeKoh Cheng Thoon - Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, SingaporePrabha Unny Krishnan - National Public Health Laboratory, National Centre for Infectious Diseases, SingaporeMichelle Lay Teng Ang - National Public Health Laboratory, National Centre for Infectious Diseases, SingaporeDouglas Su Gin Chan - Department of Laboratory Medicine, Ng Teng Fong General Hospital, SingaporeAndrea Lay Hoon Kwa - Department of Pharmacy, Singapore General Hospital, SingaporeRama Narayana Deepak - Department of Laboratory Medicine, Khoo Teck Puat Hospital, SingaporeYu Kit Chan - National Centre for Infectious Diseases, SingaporeYvonne Fu Zi Chan - Department of Infectious Diseases, Singapore General Hospital, SingaporeXiaowei Huan - National Centre for Infectious Diseases, SingaporeKyaw Zaw Linn - National Centre for Infectious Diseases, SingaporeNancy Wen Sim Tee - Department of Laboratory Medicine, National University Hospital, SingaporeThean Yen Tan - Department of Laboratory Medicine, Changi General Hospital, SingaporeTse Hsien Koh - Department of Microbiology, Singapore General Hospital, SingaporeRaymond Tzer Pin Lin - Department of Microbiology and Immunology, National University of Singapore, SingaporeLi Yang Hsu - Saw Swee Hock School Of Public Health, National University of Singapore, SingaporeSharmila Sengupta - National Centre for Infectious Diseases, SingaporeDavid L Paterson - Centre for Clinical Research, University of Queensland, Queensland, AustraliaEli Perencevich - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USAStephan Harbarth - Infection Control Program, WHO Collaborating Center for Patient Safety, Geneva University Hospitals, Geneva, SwitzerlandJeanette Teo - Department of Laboratory Medicine, National University Hospital, SingaporeIndumathi Venkatachalam - Department of Infectious Diseases, Singapore General Hospital, SingaporeCaPES Study Group
- Resource Type
- Journal article
- Publication Details
- Antimicrobial agents and chemotherapy, Vol.63(10)
- Publisher
- United States
- DOI
- 10.1128/aac.00845-19
- PMID
- 31383670
- PMCID
- PMC6761519
- ISSN
- 1098-6596
- eISSN
- 1098-6596
- Grant note
- DOI: 10.13039/501100001349, name: MOH | National Medical Research Council, award: NMRC/CIRG/1463/2016, NMRC CGAug16C005, NMRC/CSA-INV/0002/2016; DOI: 10.13039/501100001349, name: MOH | National Medical Research Council, award: CIRG18nov-0034; DOI: 10.13039/501100001459, name: Ministry of Education - Singapore, award: MOE2015-T2-2-096
- Language
- English
- Date published
- 10/2019
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984001238802771
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