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Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenemase-Producing Enterobacteriaceae. | LitMetric

AI Article Synopsis

  • - The study examined the difference between carbapenem-resistant organisms that produce carbapenemase (CPE) and those that do not (NCPCRE), focusing on how prior exposure to carbapenems affects the likelihood of encountering these resistant strains.
  • - Analysis included 843 patients and found that previous carbapenem exposure was three times more common in NCPCRE patients compared to CPE patients.
  • - Additional factors linked to CPE included being male, having a stay in intensive care, and hospitalization within the last year, indicating that specific patient demographics and medical histories influence the type of carbapenem resistance.

Article 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761519PMC
http://dx.doi.org/10.1128/AAC.00845-19DOI Listing

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