title: Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review.
abstract: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as important health care-associated pathogens. Colonization precedes infection but the risk of developing infection amongst those colonized with CRE is not clear.
  
  
  
  We searched multiple databases for studies reporting rates of CRE-colonized patients subsequently developing infection.
  
  
  
  Ten studies fulfilled our inclusion criteria, including 1,806 patients used in our analysis. All studies were observational and conducted among adult inpatients. The cumulative rate of infection was 16.5% in our study. The most common site of infection was the lung, identified in half of patients, followed in decreasing frequency by urinary tract; primary bloodstream; and skin and soft tissue, including surgical sites. Colonization or infection by CRE prolonged stay and was associated with a 10% overall mortality in our analysis.
  
  
  
  Our study results suggest an overall 16.5% risk of infection with CRE amongst patients colonized with CRE. Given the high mortality rate observed with CRE infection and the difficulty in treating these infections, research to investigate and develop strategies to eliminate the colonization state are needed.
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison, Madison, WI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Tischendorf
authors.affiliation: Universidade Federal of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
authors.forename: Rafael Almeida
authors.initials: RA
authors.lastname: de Avila
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison, Madison, WI; William S Middleton Memorial VA Hospital, Madison, WI. Electronic address: ns2@medicine.wisc.edu.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015995:Prevalence; D018570:Risk Assessment; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antibiotic; Antimicrobial; Carriage; Infection; Nonsusceptible