Distinctive Features of Ertapenem-Mono-Resistant Carbapenem-Resistant Enterobacterales in the United States: A Cohort Study.

Autor: Adelman MW; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Georgia Emerging Infections Program, Decatur, Georgia, USA., Bower CW; Georgia Emerging Infections Program, Decatur, Georgia, USA.; Atlanta VA Medical Center, Decatur, Georgia, USA.; Foundation for Atlanta Veterans Education and Research, Decatur, Georgia, USA., Grass JE; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Ansari UA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Soda EA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., See I; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Lutgring JD; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Jacob JT; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Georgia Emerging Infections Program, Decatur, Georgia, USA.; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.; Emory Antibiotic Research Center, Emory University School of Medicine, Atlanta, Georgia, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2021 Dec 29; Vol. 9 (1), pp. ofab643. Date of Electronic Publication: 2021 Dec 29 (Print Publication: 2022).
DOI: 10.1093/ofid/ofab643
Abstrakt: Background: Carbapenem-resistant Enterobacterales (CRE) are highly antibiotic-resistant bacteria. Whether CRE resistant only to ertapenem among carbapenems (ertapenem "mono-resistant") represent a unique CRE subset with regards to risk factors, carbapenemase genes, and outcomes is unknown.
Methods: We analyzed surveillance data from 9 CDC Emerging Infections Program (EIP) sites. A case was the first isolation of a carbapenem-resistant Enterobacter cloacae complex, Escherichia coli , Klebsiella aerogenes , K. oxytoca , K. pneumoniae, or K. variicola from a normally sterile site or urine in an EIP catchment area resident in 2016-2017. We compared risk factors, carbapenemase genes, antibiotic susceptibility, and mortality of ertapenem "mono-resistant" cases to "other" CRE cases (resistant to ≥1 carbapenem other than ertapenem) and analyzed risk factors for mortality.
Results: Of 2009 cases, 1249 (62.2%) were ertapenem-mono-resistant and 760 (37.8%) were other CRE. Ertapenem-mono-resistant CRE cases were more frequently ≥80 years old (29.1% vs 19.5%; P  < .0001) and female (67.9% vs 59.0%; P  < .0001). Ertapenem-mono-resistant isolates were more likely to be Enterobacter cloacae complex (48.4% vs 15.4%; P  < .0001) but less likely to be isolated from a normally sterile site (7.1% vs 11.7%; P  < .01) or to have a carbapenemase gene (2.4% vs 47.4%; P  < .0001). Ertapenem-mono-resistance was not associated with 90-day mortality in logistic regression models. Carbapenemase-positive isolates were associated with mortality (odds ratio, 1.93; 95% CI, 1.30-2.86).
Conclusions: Ertapenem-mono-resistant CRE rarely have carbapenemase genes and have distinct clinical and microbiologic characteristics from other CRE. These findings may inform antibiotic choice and infection prevention practices, particularly when carbapenemase testing is not available.
(© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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