Characteristics of community-acquired carbapenem-resistant Enterobacterales.
J Antimicrob Chemother
; 77(10): 2763-2771, 2022 09 30.
Article
em En
| MEDLINE
| ID: mdl-36179278
ABSTRACT
BACKGROUND:
Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat.METHODS:
In CRACKLE-2, we defined patients with CA-CRE as admitted from home, without pre-existing conditions, and a positive culture within 48â h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community acquisition, not admitted from home and cultured >48â h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling.RESULTS:
CA-CRE and HA-CRE were detected in 83 (10%) and 208 (26%) of 807 patients. No significant differences were observed in bacterial species or strain type distribution. K. pneumoniae (204/291, 70%) was the most common CRE species, of these 184/204 (90%) were carbapenemase producers (CPKP). The top three genetic markers in random forest models were kpi_SA15, fimE, and kpfC. Of these, kpi_SA15 (which encodes a chaperone/usher system) was positively associated (OR 3.14, 95% CI 1.13-8.87, Pâ=â0.026), and kpfC negatively associated (OR 0.21, 95% CI 0.05-0.72, Pâ=â0.015) with CA-CPKP.CONCLUSIONS:
Ten percent of CDC-defined CRE were CA. The true proportion of CA-CRE in hospitalized patients is likely lower as patients may have had unrecorded prior healthcare exposure. The kpi_SA15 operon was associated with the CA phenotype.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por Enterobacteriaceae
/
Enterobacteriáceas Resistentes a Carbapenêmicos
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos