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. 2019 Feb 1;6(2):ofz006.
doi: 10.1093/ofid/ofz006. eCollection 2019 Feb.

Increased Mortality Among Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Carriers Who Developed Clinical Isolates of Another Genotype

Wen Kai Chen  1 , Yong Yang  1 , Ban Hock Tan  2
Affiliations

Increased Mortality Among Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Carriers Who Developed Clinical Isolates of Another Genotype

Wen Kai Chen et al. Open Forum Infect Dis. .

Abstract

Background: Carbapenemase production by carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is encoded by a variety of genes on mobile genetic elements. Patients colonized by 1 genotype of CP-CRE may be subsequently infected by another genotype of CP-CRE. We sought to determine whether CP-CRE carriers who developed infection with another genotype had a higher mortality risk.

Methods: A retrospective cohort study was conducted using collected data from January 2012 to December 2016. Clinical isolates of CP-CRE were analyzed among the CP-CRE carriers who had developed an infection during their stay in the hospital. Comparison was made between CP-CRE carriers who developed clinical isolates of another genotype and those whose clinical isolates were of the same CP-CRE genotype that they were originally colonized with. The primary outcome analyzed was the 14-day mortality rate.

Results: A total of 73 CP-CRE carriers who had developed infection were analyzed. Ten (15.4%) of the carriers who developed an infection with clinical isolates of the same CP-CRE genotype died within 14 days, whereas 5 (62.5%) of those who developed an infection with clinical isolates of a different genotype died. This represented a 6-fold increase (adjusted relative risk, 6.36; 95% confidence interval, 1.75-23.06; P = .005) in the 14-day mortality rate.

Conclusions: CP-CRE carriers who developed clinical isolates of another genotype are at risk of increased mortality. This is a novel finding that is of interest to health care organizations worldwide, with profound implications for infection control measures, such as patient and staff cohorting.

Keywords: CP-CRE; carbapenem-resistant Enterobactericeae; carbapenemases; genotypes; mortality.

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Figures

Figure 1.
Figure 1.
Flow diagram of study population section.
See this image and copyright information in PMC

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