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. 2021 Apr:110:184-193.
doi: 10.1016/j.jhin.2021.01.028. Epub 2021 Feb 8.

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

S Zhao  1 , S Kennedy  2 , M R Perry  3 , J Wilson  4 , M Chase-Topping  5 , E Anderson  6 , M E J Woolhouse  7 , M Lockhart  2
Affiliations

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

S Zhao et al. J Hosp Infect. 2021 Apr.

Abstract

Background: Carbapenemase-producing organisms (CPO) have been largely responsible for the extensive spread of carbapenem resistance, and their prevalence is increasing in many parts of the world.

Aim: To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients.

Methods: All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were reviewed retrospectively. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalized linear mixed model was used to identify risk factors for mortality.

Findings: In total, 290 individuals with CPO were identified. The overall incidence increased over time (P<0.001) from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%), and Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) were the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211), while the case fatality rate was 5.7% (12/211). Age >60 years [adjusted odds ratio (aOR) 3.36, 95% confidence interval (CI) 1.06-10.63; P=0.033], presence of non-fermenters (aOR 4.88, 95% CI 1.64-14.47; P=0.005), and systemic infection or organ failure (aOR 4.21, 95% CI 1.38-12.81; P=0.032) were independently associated with 30-day mortality.

Conclusion: The incidence of CPO in Scotland is low but increasing. Awareness is required that inpatients aged >60 years, patients with systemic infection or organ failure, and patients presenting with non-fermenters are at higher risk of death from CPO.

Keywords: Carbapenemase; Epidemiology; Mortality; Risk factors.

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Figures

Figure 1
Figure 1
Incidence of carbapenemase-producing organisms (CPO) in Scotland 2003–2017. Black circles represent the incidence of CPO, and black lines represent the temporal trend in CPO incidence between 2003 and 2017. Green lines represent the temporal trend in CPO incidence before conduction of Scottish carbapenemase-producing Enterobacterales active surveillance (i.e. between 2003 and 2013), and green circles indicate the predicted incidence of CPO between 2014 and 2017 from the pre-surveillance model (2003–2013). The vertical distance between black circles and green circles represents the difference between actual incidence and predicted incidence from the pre-surveillance model between 2014 and 2017.
Figure 2
Figure 2
Specimen types of 269 carbapenemase-producing organism (CPO) isolations according to aggregate specimen (inner circle) and specific specimen (outer circle).
Figure 3
Figure 3
Temporal distribution of aggregate specimen types of 269 carbapenemase-producing organism (CPO) isolations.
Figure 4
Figure 4
Family (inner circle), genus (middle circle) and species (outer circle) of 243 carbapenemase-producing organism isolates.
See this image and copyright information in PMC

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