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Clinical epidemiology of carbapenem-resistant Gram-negative sepsis among hospitalized patients: shifting burden of disease?
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10 2018
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Source: Am J Infect Control. 46(10):1092-1096
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Alternative Title:Am J Infect Control
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Personal Author:
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Description:Background
Infections due to carbapenem-resistant Gram-negative bacilli are an emerging public health threat. However, there remains a paucity of data examining comparative incidence rates, risk factors, and outcomes in this population.
Methods
This was a single-center retrospective cohort study conducted at an urban tertiary care academic medical center. We included patients admitted (2012–2015) with: i) age ≥ 18 years; and ii) culture positive for CRE or CRNE from any site. Exclusion criteria were: i) < 2 systemic inflammatory response criteria; ii) cystic fibrosis; and iii) no targeted treatment. We evaluated hospital survival by Cox regression and year-by-year differences in the distribution of cases by Cochran-Armitage test.
Results
448 patients were analyzed (CRE, n=111 [24.8%]; CRNE, n=337 [75.2%]). CRE sepsis cases increased significantly over the study period (P<0.001), driven primarily by increasing incidence of Enterobacter spp. infection (P=0.004). There was no difference in hospital survival between patients with CRE versus CRNE sepsis (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.83–2.02; P=0.285), even after adjusting for confounding factors (adjusted HR, 1.08; 95% CI, 0.62–1.87; P=0.799).
Conclusions
Clinical outcomes did not differ between patients with CRE versus CRNE sepsis. Dramatic increases in CRE, particularly Enterobacter spp., appear to be causing a shift in the burden of clinically significant carbapenem-resistant Gram-negative infection.
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Pubmed ID:29706365
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Pubmed Central ID:PMC6165681
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