Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis.
BACKGROUND
Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls.


METHODS
Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed.


RESULTS
Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001].


CONCLUSIONS
Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity.
Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
Christopher
C
Bogan
Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
Keith S
KS
Kaye
Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
Teena
T
Chopra
Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
Kayoko
K
Hayakawa
Department of Pharmacy Services, Detroit Medical Center, Wayne State University, Detroit, MI.
Jason M
JM
Pogue
Department of Clinical Microbiology, Detroit Medical Center, Wayne State University, Detroit, MI.
Paul R
PR
Lephart
Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
Suchitha
S
Bheemreddy
Department of Clinical Microbiology, Assaf Harofeh Medical Center, Zerifin, Israel.
Tsilia
T
Lazarovitch
Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
Ronit
R
Zaidenstein
VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH.
Federico
F
Perez
VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH; Research Service, Veterans Affairs Medical Center, Cleveland, OH; Department of Pharmacology, Case Western Reserve University, Cleveland, OH; Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, OH.
Robert A
RA
Bonomo
Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: drormc@hotmail.com.
Dror
D
Marchaim
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology; D016022:Case-Control Studies; D003422:Critical Care; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000378:metabolism / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009735:Nursing Homes; D010351:Patient Discharge; D012307:Risk Factors; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases
CRE; Case control; Cohort study; KPC; Outcome; Risk factors