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Characteristics of community-acquired carbapenem-resistant Enterobacterales.

Publication ,  Journal Article
Shrestha, R; Luterbach, CL; Dai, W; Komarow, L; Earley, M; Weston, G; Herc, E; Jacob, JT; Salata, R; Wong, D; Anderson, D; Rydell, KB ...
Published in: J Antimicrob Chemother
September 30, 2022

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 48 h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community acquisition, not admitted from home and cultured >48 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, P = 0.026), and kpfC negatively associated (OR 0.21, 95% CI 0.05-0.72, P = 0.015) 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.

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Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

September 30, 2022

Volume

77

Issue

10

Start / End Page

2763 / 2771

Location

England

Related Subject Headings

  • beta-Lactamases
  • Microbiology
  • Klebsiella pneumoniae
  • Humans
  • Genetic Markers
  • Enterobacteriaceae Infections
  • Carbapenems
  • Carbapenem-Resistant Enterobacteriaceae
  • Bacterial Proteins
  • Anti-Bacterial Agents
 

Citation

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Shrestha, R., Luterbach, C. L., Dai, W., Komarow, L., Earley, M., Weston, G., … MDRO Investigators, . (2022). Characteristics of community-acquired carbapenem-resistant Enterobacterales. J Antimicrob Chemother, 77(10), 2763–2771. https://doi.org/10.1093/jac/dkac239
Shrestha, Rima, Courtney L. Luterbach, Weixiao Dai, Lauren Komarow, Michelle Earley, Gregory Weston, Erica Herc, et al. “Characteristics of community-acquired carbapenem-resistant Enterobacterales.J Antimicrob Chemother 77, no. 10 (September 30, 2022): 2763–71. https://doi.org/10.1093/jac/dkac239.
Shrestha R, Luterbach CL, Dai W, Komarow L, Earley M, Weston G, et al. Characteristics of community-acquired carbapenem-resistant Enterobacterales. J Antimicrob Chemother. 2022 Sep 30;77(10):2763–71.
Shrestha, Rima, et al. “Characteristics of community-acquired carbapenem-resistant Enterobacterales.J Antimicrob Chemother, vol. 77, no. 10, Sept. 2022, pp. 2763–71. Pubmed, doi:10.1093/jac/dkac239.
Shrestha R, Luterbach CL, Dai W, Komarow L, Earley M, Weston G, Herc E, Jacob JT, Salata R, Wong D, Anderson D, Rydell KB, Arias CA, Chen L, van Duin D, MDRO Investigators. Characteristics of community-acquired carbapenem-resistant Enterobacterales. J Antimicrob Chemother. 2022 Sep 30;77(10):2763–2771.
Journal cover image

Published In

J Antimicrob Chemother

DOI

EISSN

1460-2091

Publication Date

September 30, 2022

Volume

77

Issue

10

Start / End Page

2763 / 2771

Location

England

Related Subject Headings

  • beta-Lactamases
  • Microbiology
  • Klebsiella pneumoniae
  • Humans
  • Genetic Markers
  • Enterobacteriaceae Infections
  • Carbapenems
  • Carbapenem-Resistant Enterobacteriaceae
  • Bacterial Proteins
  • Anti-Bacterial Agents