Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 27;4(3):ofx157.
doi: 10.1093/ofid/ofx157. eCollection 2017 Summer.

A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae

Oryan Henig  1 , Eric Cober  2 , Sandra S Richter  3 , Federico Perez  4   5 , Robert A Salata  5 , Robert C Kalayjian  6 , Richard R Watkins  7   8 , Steve Marshall  4 , Susan D Rudin  4   9 , T Nicholas Domitrovic  4   9 , Andrea M Hujer  4   9 , Kristine M Hujer  4   9 , Yohei Doi  10 , Scott Evans  11 , Vance G Fowler Jr  12   13 , Robert A Bonomo  4   5   9   14   15   16   17 , David van Duin  18 , Keith S Kaye  1 ; Antibacterial Resistance Leadership Group
Affiliations

A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae

Oryan Henig et al. Open Forum Infect Dis. .

Abstract

Background: This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE).

Methods: Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR.

Results: One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from long-term care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93).

Conclusions: Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

Keywords: Klebsiella pneumoniae; ST258; carbapenem-resistant Enterobacteriaceae; surgical site infections; wound infection.

PubMed Disclaimer

References

    1. Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 2001; 14:244–69. - PMC - PubMed
    1. Halbert AR, Stacey MC, Rohr JB, Jopp-McKay A. The effect of bacterial colonization on venous ulcer healing. Australas J Dermatol 1992; 33:75–80. - PubMed
    1. Akers KS, Mende K, Cheatle KA et al. . Biofilms and persistent wound infections in United States military trauma patients: a case-control analysis. BMC Infect Dis 2014; 14:190. - PMC - PubMed
    1. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002; 15:167–93. - PMC - PubMed
    1. Vuotto C, Longo F, Balice MP et al. . Antibiotic resistance related to biofilm formation in Klebsiella pneumoniae. Pathogens 2014; 3:743–58. - PMC - PubMed