Risk Factors Associated with Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Positive Cultures in a Cohort of U.S. Veterans

Geneva M Wilson; Katie J Suda; Margaret A Fitzpatrick; Brian Bartle; Christopher D Pfeiffer; Makoto Jones; Michael A Rubin; Eli Perencevich; Martin Evans; Charlesnika T Evans

doi:10.1093/cid/ciab415

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Risk Factors Associated with Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Positive Cultures in a Cohort of U.S. Veterans

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Risk Factors Associated with Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Positive Cultures in a Cohort of U.S. Veterans

Geneva M Wilson, Katie J Suda, Margaret A Fitzpatrick, Brian Bartle, Christopher D Pfeiffer, Makoto Jones, Michael A Rubin, Eli Perencevich, Martin Evans and Charlesnika T Evans

Clinical infectious diseases, Vol.73(8), pp.1370-1378

05/11/2021

DOI: 10.1093/cid/ciab415

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Abstract

Abstract Introduction Carbapenem-resistant Enterobacterales (CRE) cause approximately 13,100 infections with 8% mortality in the United States annually. The subset of carbapenemase-producing CRE (CP-CRE) infections have much higher mortality rates (40% -50%). There has been little research on characteristics unique to CP-CRE. The goal of this study was to assess differences between those with nonCP-CRE and CP-CRE cultures in U.S. Veterans. Methods A retrospective cohort of Veterans with CRE cultures from 2013-2018 and their demographic, medical, and facility level covariates were collected. Clustered multiple logistic regression models were used to assess independent factors associated with CP-CRE. Results 3,096 unique patients with cultures positive for either nonCP-CRE or CP-CRE were included. Being African American (Odds Ratio (OR)=1.44 (95% Confidence Interval (CI) 1.15,1.80), diagnosis in 2017 (OR=3.11 (95% CI 2.13,4.54)) or 2018 (OR=3.93 (95%CI 2.64,5.84)), congestive heart failure (OR=1.35 (95%CI 1.11,1.64)), and gastroesophageal reflux disease (OR=1.39 (95%CI 1.03,1.87)) were associated with CP-CRE cultures. 752 (24.3%) patients had no known antibiotic exposure in the year before culture; these individuals had a comparatively increased frequency of prolonged PPI use (17.3% vs 5.6%). Discussion Among a cohort of patients with CRE, African Americans, individuals with congestive heart failure, and patients with gastroesophageal reflux disease had greater odds of having a CP-CRE culture. Roughly one in four patients with CP-CRE had no known antibiotic exposure in the year before their positive culture.

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Title: Subtitle: Risk Factors Associated with Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Positive Cultures in a Cohort of U.S. Veterans
Creators: Geneva M Wilson - Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL,USA
Katie J Suda - Center for Health Equity Research and Promotion, VA Pittsburgh Heath Care System, Pittsburgh, PA, USA, University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, PA, USA
Margaret A Fitzpatrick - Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL,USA, Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
Brian Bartle - Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL,USA
Christopher D Pfeiffer - Department of Veterans Affairs, Portland VA Healthcare System, Portland, OR, USA, Department of Medicine, Division of Infectious Diseases, Oregon Health Science University, Portland, OR, USA
Makoto Jones - Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA, Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
Michael A Rubin - Department of Veterans Affairs, Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Eli Perencevich - Department of Veterans Affairs, Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Martin Evans - Department of Veterans Affairs, Lexington VA Medical Center, Lexington, KY, USA
Charlesnika T Evans - Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL,USA, Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.73(8), pp.1370-1378
DOI: 10.1093/cid/ciab415
ISSN: 1058-4838
eISSN: 1537-6591
Grant note: DOI: 10.13039/100007181, name: Quality Enhancement Research Initiative, award: QUE 15–269; name: research career scientist, award: RCS 20–192
Language: English
Date published: 05/11/2021
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9984077780202771

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