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. 2021 Aug;42(8):962-967.
doi: 10.1017/ice.2020.1325. Epub 2020 Dec 10.

Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study

Jessica R Howard-Anderson  1   2 , Chris W Bower  2   3   4 , Gillian Smith  2   3   4 , Mary Elizabeth Sexton  1 , Monica M Farley  1   2   3 , Sarah W Satola  1   2   3 , Jesse T Jacob  1   2
Affiliations

Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study

Jessica R Howard-Anderson et al. Infect Control Hosp Epidemiol. 2021 Aug.

Abstract

Objective: To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia.

Design: Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year.

Setting: The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia.

Patients: Residents of HD3 with CRE first identified in urine between 2012 and 2017.

Results: We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8-34.9), central venous catheter (OR, 4.3; 95% CI, 1.7-10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6-11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3-25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1-7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2-23.6).

Conclusions: In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.

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Conflict of interest statement

Potential conflicts of interest

All authors report no conflicts of interest relevant to this article.

References

    1. CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
    1. Tacconelli E, Magrini N. Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery and Development of New Antibiotics. [Internet]. Geneva: World Health Organization; [Cited 2019 Dec 19]. Available from:Https://Www.Who.Int/Medicines/Publications/WHO-PPL-Short_Summary_25Feb-E....
    1. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009;9(4):228–236. - PubMed
    1. Guh AY, Bulens SN, Mu Y, et al.Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012–2013. JAMA. 2015;314(14):1479–1487. - PMC - PubMed
    1. Satlin MJ, Kubin CJ, Blumenthal JS, et al.Comparative Effectiveness of Aminoglycosides, Polymyxin B, and Tigecycline for Clearance of Carbapenem-Resistant Klebsiella pneumoniae from Urine. Antimicrob Agents Chemother. 2011;55(12):5893–5899. - PMC - PubMed

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