Incidence and Time-to-Onset of Carbapenemase-Producing Enterobacterales (CPE) Infections in CPE Carriers: a Retrospective Cohort Study

Overview

Journal Microbiol Spectr

Specialty Microbiology

Date 2022 Nov 2

PMID 36321906

Authors

B Hoellinger

S Deboscker

F Danion

T Lavigne

F Severac

Y Ruch

A Ursenbach

N Lefebvre

P Boyer

Y Hansmann

Affiliations

Soon will be listed here.

Abstract

This study aimed to assess the proportion of carbapenemase-producing Enterobacterales (CPE) infections among all infectious episodes in CPE carriers, compare the time-to-onset of CPE infections with that of other infections, assess the mortality of patients with CPE infections, and identify risk factors for CPE infections in CPE carriers. A retrospective cohort study was performed over a 10-year period in our University Hospital, and 274 CPE carriers were identified. All infectious episodes within the first 6 months following the diagnosis of CPE rectal carriage were considered. Risk factor analysis for CPE infections in CPE carriers was performed by univariate and multivariate analyses. This study revealed an incidence of 24.1% (66/274) of CPE infection within 6 months of CPE carriage diagnosis. The 28-day all-cause mortality due to CPE infections was 25.7%. CPE infections represented 52.6% (70/133) of all infectious episodes in CPE carriers in the first 6 months following CPE carriage detection, and these significantly occurred earlier than non-CPE infections, with a median time of 15 versus 51 days, respectively ( < 0.01). Based on the multivariate analysis, prior neurological disease was the only risk factor associated with CPE infections in CPE carriers. CPE infections have an early onset, accounting for a large proportion of infections in CPE carriers, and are associated with high mortality. Carbapenemase-producing Enterobacterales (CPE) infections are emerging infections and may represent a therapeutic challenge, while effective antibiotic therapy is likely to be delayed. We aimed to assess the proportion of CPE infections in CPE carriers and to identify risk factors of CPE infections among this population that could guide empirical antibiotic therapy. We showed that CPE infections are frequent in CPE carriers, have an early onset after CPE carriage diagnosis, and represent a significant proportion of all infectious episodes in CPE carriers. No significant risk factors for CPE infections could be identified. Overall, this study suggests that empirical antibiotic treatment covering CPE might be initiated in CPE carriers at least in the first month after its diagnosis and in severe infections due to the high frequency and early occurrence of CPE infections in these patients.

Citing Articles

Key concepts in diagnosing infection - when to treat and when not to.

Hayton D, Wickramasinghe D Clin Med (Lond). 2024; 24(6):100264.

PMID: 39528021 PMC: 11617389. DOI: 10.1016/j.clinme.2024.100264.

Evaluation of the Xpert Carba-R assay for quantifying carbapenemase-producing bacterial load in stool samples.

Chua J, Lim Z, Loy S, Koh V, Thevasagayam N, Huan X PLoS One. 2024; 19(8):e0309089.

PMID: 39196974 PMC: 11356397. DOI: 10.1371/journal.pone.0309089.

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting.

Pham T, Nguyen T, My T, Le L, Vu H, Hoang N JAC Antimicrob Resist. 2024; 6(3):dlae089.

PMID: 38863560 PMC: 11166082. DOI: 10.1093/jacamr/dlae089.

References

Borer A, Saidel-Odes L, Eskira S, Nativ R, Riesenberg K, Livshiz-Riven I . Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae. Am J Infect Control. 2011; 40(5):421-5. DOI: 10.1016/j.ajic.2011.05.022. View

Aspevall O, HALLANDER H, Gant V, Kouri T . European guidelines for urinalysis: a collaborative document produced by European clinical microbiologists and clinical chemists under ECLM in collaboration with ESCMID. Clin Microbiol Infect. 2001; 7(4):173-8. DOI: 10.1046/j.1198-743x.2001.00237.x. View

Ruppe E, Armand-Lefevre L, Estellat C, Consigny P, El Mniai A, Boussadia Y . High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics. Clin Infect Dis. 2015; 61(4):593-600. DOI: 10.1093/cid/civ333. View

Nair G, Niederman M . Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2014; 41(1):34-48. PMC: 7095124. DOI: 10.1007/s00134-014-3564-5. View

Tumbarello M, Raffaelli F, Giannella M, Mantengoli E, Mularoni A, Venditti M . Ceftazidime-Avibactam Use for Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Infections: A Retrospective Observational Multicenter Study. Clin Infect Dis. 2021; 73(9):1664-1676. DOI: 10.1093/cid/ciab176. View

Navarro-San Francisco C, Mora-Rillo M, Romero-Gomez M, Moreno-Ramos F, Rico-Nieto A, Ruiz-Carrascoso G . Bacteraemia due to OXA-48-carbapenemase-producing Enterobacteriaceae: a major clinical challenge. Clin Microbiol Infect. 2012; 19(2):E72-9. DOI: 10.1111/1469-0691.12091. View

Wunderink R, Giamarellos-Bourboulis E, Rahav G, Mathers A, Bassetti M, Vazquez J . Effect and Safety of Meropenem-Vaborbactam versus Best-Available Therapy in Patients with Carbapenem-Resistant Enterobacteriaceae Infections: The TANGO II Randomized Clinical Trial. Infect Dis Ther. 2018; 7(4):439-455. PMC: 6249182. DOI: 10.1007/s40121-018-0214-1. View

Shields R, Nguyen M, Chen L, Press E, Potoski B, Marini R . Ceftazidime-Avibactam Is Superior to Other Treatment Regimens against Carbapenem-Resistant Klebsiella pneumoniae Bacteremia. Antimicrob Agents Chemother. 2017; 61(8). PMC: 5527595. DOI: 10.1128/AAC.00883-17. View

Tischendorf J, Avila R, Safdar N . Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review. Am J Infect Control. 2016; 44(5):539-43. PMC: 5262497. DOI: 10.1016/j.ajic.2015.12.005. View

10.

Ramos-Castaneda J, Ruano-Ravina A, Barbosa-Lorenzo R, Paillier-Gonzalez J, Saldana-Campos J, Salinas D . Mortality due to KPC carbapenemase-producing Klebsiella pneumoniae infections: Systematic review and meta-analysis: Mortality due to KPC Klebsiella pneumoniae infections. J Infect. 2018; 76(5):438-448. DOI: 10.1016/j.jinf.2018.02.007. View

11.

Poole K, George R, Decraene V, Shankar K, Cawthorne J, Savage N . Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization. J Hosp Infect. 2016; 94(2):125-9. DOI: 10.1016/j.jhin.2016.06.019. View

12.

Daikos G, Markogiannakis A . Carbapenemase-producing Klebsiella pneumoniae: (when) might we still consider treating with carbapenems?. Clin Microbiol Infect. 2011; 17(8):1135-41. DOI: 10.1111/j.1469-0691.2011.03553.x. View

13.

Giannella M, Trecarichi E, De Rosa F, Del Bono V, Bassetti M, Lewis R . Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect. 2014; 20(12):1357-62. DOI: 10.1111/1469-0691.12747. View

14.

Lawandi A, Yek C, Kadri S . IDSA guidance and ESCMID guidelines: complementary approaches toward a care standard for MDR Gram-negative infections. Clin Microbiol Infect. 2022; 28(4):465-469. DOI: 10.1016/j.cmi.2022.01.030. View

15.

Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S . Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet. 1999; 354(9184):1071-7. DOI: 10.1016/s0140-6736(98)11134-0. View

16.

Schechner V, Kotlovsky T, Kazma M, Mishali H, Schwartz D, Navon-Venezia S . Asymptomatic rectal carriage of blaKPC producing carbapenem-resistant Enterobacteriaceae: who is prone to become clinically infected?. Clin Microbiol Infect. 2012; 19(5):451-6. DOI: 10.1111/j.1469-0691.2012.03888.x. View

17.

Dortet L, Cuzon G, Plesiat P, Naas T . Prospective evaluation of an algorithm for the phenotypic screening of carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother. 2015; 71(1):135-40. DOI: 10.1093/jac/dkv308. View

18.

Woodworth M, Hayden M, Young V, Kwon J . The Role of Fecal Microbiota Transplantation in Reducing Intestinal Colonization With Antibiotic-Resistant Organisms: The Current Landscape and Future Directions. Open Forum Infect Dis. 2019; 6(7). PMC: 6667716. DOI: 10.1093/ofid/ofz288. View

19.

Chen X, Liu Q, Liu W, Yan Q . Risk Factors for Subsequential Carbapenem-Resistant Clinical Infection Among Rectal Carriers with Carbapenem-Resistant . Infect Drug Resist. 2020; 13:1299-1305. PMC: 7211322. DOI: 10.2147/IDR.S247101. View