TY - JOUR
T1 - Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections
AU - MDRO Network Investigators and the Antibacterial Resistance Leadership Group
AU - Boutzoukas, Angelique E.
AU - Mackow, Natalie
AU - Giri, Abhigya
AU - Komarow, Lauren
AU - Hill, Carol
AU - Chen, Liang
AU - Doi, Yohei
AU - Satlin, Michael J.
AU - Arias, Cesar
AU - Wang, Minggui
AU - Moreo, Laura Mora
AU - Herc, Erica
AU - Cober, Eric
AU - Weston, Gregory
AU - Patel, Robin
AU - Bonomo, Robert A.
AU - Fowler, Vance
AU - van Duin, David
AU - Banerjee, Ritu
AU - Boucher, Helen
AU - Chambers, Henry
AU - Cosgrove, Sara
AU - Cross, Heather
AU - Doernberg, Sarah
AU - Dixon, Dennis
AU - Evans, Scott
AU - Ghazaryan, Varduhi
AU - Hamasaki, Toshi
AU - Hanson, Kim
AU - Harris, Anthony
AU - Holland, Thomas
AU - Lautenbach, Ebbing
AU - Lodise, Tom
AU - Mehigan, Maureen
AU - Moon, Kyung
AU - Paterson, David
AU - Pettigrew, Melinda
AU - Raterman, Erica
AU - Samuel, Tamika
AU - Shelburne, Sam
AU - Zou, Lanling
AU - Kanj, Souha S.
AU - Jabbour, Jean Francois
AU - Zhang, Fujie
AU - Lok, Judith J.
AU - Salata, Robert A.
AU - Stryjewski, Martin
AU - Di Castelnuovo, Valentina
AU - Valderrama, Sandra
AU - Reyes, Jinnethe
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/11/1
Y1 - 2024/11/1
N2 - Background: The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI). Methods: Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI. Results: Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P< 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P= 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P< 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P< 0.001]. Conclusion: We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.
AB - Background: The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI). Methods: Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI. Results: Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P< 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P= 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P< 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P< 0.001]. Conclusion: We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.
UR - https://www.scopus.com/pages/publications/85208514340
U2 - 10.1093/jac/dkae306
DO - 10.1093/jac/dkae306
M3 - Article
C2 - 39236214
AN - SCOPUS:85208514340
SN - 0305-7453
VL - 79
SP - 2916
EP - 2922
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 11
ER -
SDG 3 Good Health and Well-being