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. 2023 Jan;51(1):70-77.
doi: 10.1016/j.ajic.2022.04.003. Epub 2022 Jul 28.

Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors -Emerging infections program, United States, 2012-2015

Sandra N Bulens  1 , Hannah E Reses  2 , Uzma A Ansari  2 , Julian E Grass  2 , Clayton Carmon  2 , Valerie Albrecht  2 , Adrian Lawsin  2 , Gillian McAllister  2 , Jonathan Daniels  2 , Yeon-Kyeng Lee  2 , Sarah Yi  2 , Isaac See  3 , Jesse T Jacob  4 , Chris W Bower  5 , Lucy Wilson  6 , Elisabeth Vaeth  6 , Ruth Lynfield  7 , Paula Snippes Vagnone  7 , Kristin M Shaw  7 , Ghinwa Dumyati  8 , Rebecca Tsay  8 , Erin C Phipps  9 , Wendy Bamberg  10 , Sarah J Janelle  10 , Zintars G Beldavs  11 , P Maureen Cassidy  11 , Marion Kainer  12 , Daniel Muleta  12 , Jacquelyn T Mounsey  12 , Alison Laufer-Halpin  3 , Maria Karlsson  2 , Joseph D Lutgring  2 , Maroya Spalding Walters  3
Affiliations

Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors -Emerging infections program, United States, 2012-2015

Sandra N Bulens et al. Am J Infect Control. 2023 Jan.

Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) are usually healthcare-associated but are also emerging in the community.

Methods: Active, population-based surveillance was conducted to identify case-patients with cultures positive for Enterobacterales not susceptible to a carbapenem (excluding ertapenem) and resistant to all third-generation cephalosporins tested at 8 US sites from January 2012 to December 2015. Medical records were used to classify cases as health care-associated, or as community-associated (CA) if a patient had no known health care risk factors and a culture was collected <3 days after hospital admission. Enterobacterales isolates from selected cases were submitted to CDC for whole genome sequencing.

Results: We identified 1499 CRE cases in 1194 case-patients; 149 cases (10%) in 139 case-patients were CA. The incidence of CRE cases per 100,000 population was 2.96 (95% CI: 2.81, 3.11) overall and 0.29 (95% CI: 0.25, 0.35) for CA-CRE. Most CA-CRE cases were in White persons (73%), females (84%) and identified from urine cultures (98%). Among the 12 sequenced CA-CRE isolates, 5 (42%) harbored a carbapenemase gene.

Conclusions: Ten percent of CRE cases were CA; some isolates from CA-CRE cases harbored carbapenemase genes. Continued CRE surveillance in the community is critical to monitor emergence outside of traditional health care settings.

Keywords: Carbapenemase-producing enterobacterales; Carbapenems; Community-associated disease; Healthcare-associated infections; Multi-drug resistant gram-negative organisms.

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Conflict of interest statement

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Included authors have nothing to disclose.

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