title: Clinical Significance of Community- and Healthcare-Acquired Carbapenem-Resistant Enterobacteriaceae Isolates.
abstract: This study was conducted to investigate the clinical significance, manifestations, microbiological characteristics and outcomes of carbapenem-resistant Enterobacteriaceae (CRE) isolates, and compare the clinical features of community- and healthcare-acquired CRE isolates. A total of 78 patients were identified to have CRE. Klebsiella pneumoniae was the most common pathogens (n = 42, 53.8%), followed by Enterobacter cloacae (n = 24, 30.8%), and Escherichia coli (n = 11, 14.1%). Most of the patients acquired CRE from healthcare settings (n = 55, 70.5%), and other cases got CRE from community settings (n = 23, 29.5%). Nine cases (11.5%) were classified as CRE colonization. Among the remaining 69 cases of CRE infections, pneumonia (n = 28, 40.6%) was the most common type of infections, followed by urinary tract infection (n = 24, 34.8%), and intra-abdominal infection (n = 16, 23.2%). The patients acquired CRE from community settings were more likely to be elderly, female, and had more urinary tract infections than from healthcare settings. In contrast, the patients acquired CRE from healthcare settings had more intra-abdominal infections, intra-abdominal surgery, and presence of indwelling device than from community settings. In conclusion, community-acquired CRE are not rare, and their associated clinical presentations are different from healthcare-acquired CRE.
authors.affiliation: Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan.|Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Tang
authors.affiliation: Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Cheng-Fang
authors.initials: CF
authors.lastname: Hsieh
authors.affiliation: Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Ping-Chin
authors.initials: PC
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Jyh-Jou
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: The Committee of Infection Control, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.|Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Chao
authors.affiliation: Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.|Department of Medical Research, Chi Mei Medical Center,Tainan, Taiwan.
authors.forename: Yin-Ching
authors.initials: YC
authors.lastname: Chuang
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology*; D017714:Community-Acquired Infections / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D018440:beta-Lactam Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems