Risk factors for infections caused by carbapenem-resistant Enterobacterales : an international matched case-control-control study (EURECA)
© 2023 The Author(s)..
Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials.
Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors.
Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results.
Interpretation: The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics.
Funding: The study was funded by the Innovative Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
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| Enthalten in: |
EClinicalMedicine - 57(2023) vom: 01. März, Seite 101871 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pérez-Galera, Salvador [VerfasserIn] |
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| Links: |
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| Themen: |
Antimicrobial resistance |
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| Anmerkungen: |
Date Revised 11.03.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.eclinm.2023.101871 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM354014943 |
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| 245 | 1 | 0 | |a Risk factors for infections caused by carbapenem-resistant Enterobacterales |b an international matched case-control-control study (EURECA) |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023 The Author(s). | ||
| 520 | |a Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials | ||
| 520 | |a Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors | ||
| 520 | |a Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results | ||
| 520 | |a Interpretation: The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics | ||
| 520 | |a Funding: The study was funded by the Innovative Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antimicrobial resistance | |
| 650 | 4 | |a Carbapenem-resistant Enterobacterales | |
| 650 | 4 | |a KPC | |
| 650 | 4 | |a Metallo-beta-lactamases | |
| 650 | 4 | |a OXA | |
| 650 | 4 | |a Risk factors | |
| 700 | 1 | |a Bravo-Ferrer, Jose M |e verfasserin |4 aut | |
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| 700 | 1 | |a Palacios, Zaira |e investigator |4 oth | |
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| 700 | 1 | |a Maldonado, Natalia |e investigator |4 oth | |
| 700 | 1 | |a Ciezar, Antonio Plata |e investigator |4 oth | |
| 700 | 1 | |a Ruiz Mesa, Juan Diego |e investigator |4 oth | |
| 700 | 1 | |a Diaz, Beatriz Sobrino |e investigator |4 oth | |
| 700 | 1 | |a Gomez, Ignacio Marquez |e investigator |4 oth | |
| 700 | 1 | |a Camacho, Ines Perez |e investigator |4 oth | |
| 700 | 1 | |a Frutos-Adame, Azahara |e investigator |4 oth | |
| 700 | 1 | |a Guzman-Puche, Julia |e investigator |4 oth | |
| 700 | 1 | |a Gracia-Ahufinger, Irene |e investigator |4 oth | |
| 700 | 1 | |a Perez-Nadales, Elena |e investigator |4 oth | |
| 700 | 1 | |a Torre-Gimenez, Julian |e investigator |4 oth | |
| 700 | 1 | |a Pyrpasopoulou, Athina |e investigator |4 oth | |
| 700 | 1 | |a Iosifidis, Elias |e investigator |4 oth | |
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| 700 | 1 | |a Radovanovic, Ivana |e investigator |4 oth | |
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| 700 | 1 | |a Legakis, Nikolaos J |e investigator |4 oth | |
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| 700 | 1 | |a Gijón-Cordero, Desirée |e investigator |4 oth | |
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| 700 | 1 | |a Dalekos, George N |e investigator |4 oth | |
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| 700 | 1 | |a Michos, Athanasios |e investigator |4 oth | |
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| 700 | 1 | |a Cavallo, Rossana |e investigator |4 oth | |
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