Carbapenem-Resistant Enterobacterales Bacteriuria and Subsequent Bacteremia: A Population-Based Study

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Howard-Anderson, Jessica ; Bower, Chris W ; Smith, Gillian ; Sexton, Mary Elizabeth ; Farley, Monica M ; Satola, Sarah W ; Jacob, Jesse T
• Description:
  Objective:
  
  To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and determine if urinary catheters increase the risk of subsequent CRE bacteremia.
  
  Design:
  
  Using active population- and laboratory- based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within one year.
  
  Setting:
  
  8 county Georgia Health District 3 (HD3) in Atlanta, GA.
  
  Patients:
  
  Residents of HD3 with CRE first identified in urine between 2012–2017.
  
  Results:
  
  We identified 464 patients with CRE bacteriuria (mean yearly incidence 1.96 cases/100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 (5%) patients developed CRE bacteremia with the same organism within one year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR] 8.0, 95% confidence interval [CI] 1.8–34.9), central venous catheter (OR 4.3, 95% CI 1.7–10.6) or another indwelling device (OR 4.3, 95% CI 1.6–11.4), urine culture obtained as an inpatient (OR 5.7, 95% CI 1.3–25.9) and being in the ICU in the week prior to urine culture (OR 2.9, 95% CI 1.1–7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR 5.3, 95% CI 1.2–23.6).
  
  Conclusions:
  
  In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should target reducing inappropriate insertion and early removal of urinary catheters.
  
  
• Subjects:
  Article
• Source:
  Infect Control Hosp Epidemiol. 42(8):962-967
• Pubmed ID:
  33298218
• Pubmed Central ID:
  PMC8190175
• Document Type:
  Journal Article
• Funding:
  UM1 AI104681/AI/NIAID NIH HHSUnited States/ ; UL1 TR002378/TR/NCATS NIH HHSUnited States/ ; U54 CK000485/CK/NCEZID CDC HHSUnited States/ ; TL1 TR002382/TR/NCATS NIH HHSUnited States/ ; U54CK000485/ACL/ACL HHSUnited States/ ; U54 CK000164/CK/NCEZID CDC HHSUnited States/
• Volume:
  42
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:56593cf278598c8430f09cf819acb7e7109512e6145dc911411117bf5531fa2f
• Download URL:
  https://stacks.cdc.gov/view/cdc/107262/cdc_107262_DS1.pdf
• File Type:
  [PDF - 335.10 KB ]