Factors associated with carriage of carbapenem-non-susceptible Enterobacteriaceaein North-Eastern France and outcomes of infected patients.
Carbapenems are frequently used as a last resort to treat infections caused by multidrug-resistant Gram-negative organisms, thus carbapenem-non-susceptible Enterobacteriaceae (CNSE) is an emerging health threat.



To assess risk factors and outcomes of CNSE carriage.



We conducted a matched case-control study in six hospitals in North-Eastern France. The controls were patients harbouring carbapenem-susceptible Enterobacteriaceae. Fifty-five cases and 110 controls were included.



Most of the CNSE isolates were Enterobacter cloacae and Klebsiella pneumoniae . Carbapenemase production was observed in 40% of isolates and they produced OXA-48 only. CNSE carriage was significantly associated with recent antibiotic use ( P =  0.014), particularly carbapenems ( P =  0.03) and fluoroquinolones ( P =  0.016). A multivariate analysis using conditional logistic regression showed that the presence of concomitant infection(s) (OR: 9.83; 95% CI 3.04-21.39, P =  0.0031), nosocomial infections (OR: 7.84; 95% CI 2.00-12.54, P  =   0.0063) and a high age (OR: 1.07; 95% CI 1.01-1.06, P =  0.038) were independently associated with CNSE carriage. Moreover, patients infected with CNSE had worse outcomes: fewer resolved infections at 1 month ( P =  0.02), and they had a higher mortality rate ( P =  0.0004) and longer hospital stays ( P =  0.02).



We identified three independent risk factors for CNSE carriage as well as worse outcomes in infected patients in North-Eastern France. This highlights the importance of early detection of CNSE and the need for antimicrobial therapy re-evaluation after bacteriological analysis has been performed.
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Anaëlle
A
Muggeo
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Thomas
T
Guillard
Unité d'aide méthodologique, Pôle recherche et santé publique, Hôpital Robert Debré, CHU Reims, Reims, France.
Coralie
C
Barbe
Unité d'aide méthodologique, Pôle recherche et santé publique, Hôpital Robert Debré, CHU Reims, Reims, France.
Aurore
A
Thierry
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Odile
O
Bajolet
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Véronique
V
Vernet-Garnier
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Anne
A
Limelette
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Lucien
L
Brasme
Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Hôpital Robert Debré, CHU Reims, Reims, France.|Structure Fédérative de Recherche CAP-Santé EA4687, UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France.
Christophe
C
De Champs
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D015780:Carbapenems / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D003428:Cross Infection; D016972:Enterobacter cloacae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D015780:Carbapenems