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. 2023 Dec 5;10(12):ofad609.
doi: 10.1093/ofid/ofad609. eCollection 2023 Dec.

Trends in Incidence of Carbapenem-Resistant Enterobacterales in 7 US Sites, 2016─2020

Nadezhda Duffy  1 , Rongxia Li  1 , Christopher A Czaja  2 , Helen Johnston  2 , Sarah J Janelle  2 , Jesse T Jacob  3   4 , Gillian Smith  3   4   5 , Lucy E Wilson  6 , Elisabeth Vaeth  6 , Ruth Lynfield  7 , Sean O'Malley  7 , Paula Snippes Vagnone  7 , Ghinwa Dumyati  8 , Rebecca Tsay  8 , Sandra N Bulens  1 , Julian E Grass  1 , Rebecca Pierce  9 , P Maureen Cassidy  9 , Heather Hertzel  9 , Christopher Wilson  10 , Daniel Muleta  10 , Jacquelyn Taylor  10 , Alice Y Guh  1
Affiliations

Trends in Incidence of Carbapenem-Resistant Enterobacterales in 7 US Sites, 2016─2020

Nadezhda Duffy et al. Open Forum Infect Dis. .

Abstract

Background: We described changes in 2016─2020 carbapenem-resistant Enterobacterales (CRE) incidence rates in 7 US sites that conduct population-based CRE surveillance.

Methods: An incident CRE case was defined as the first isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. resistant to ≥1 carbapenem from a sterile site or urine in a surveillance area resident in a 30-day period. We reviewed medical records and classified cases as hospital-onset (HO), healthcare-associated community-onset (HACO), or community-associated (CA) CRE based on healthcare exposures and location of disease onset. We calculated incidence rates using census data. We used Poisson mixed effects regression models to perform 2016─2020 trend analyses, adjusting for sex, race/ethnicity, and age. We compared adjusted incidence rates between 2016 and subsequent years using incidence rate ratios (RRs) and 95% confidence intervals (CIs).

Results: Of 4996 CRE cases, 62% were HACO, 21% CA, and 14% HO. The crude CRE incidence rate per 100 000 was 7.51 in 2016 and 6.08 in 2020 and was highest for HACO, followed by CA and HO. From 2016 to 2020, the adjusted overall CRE incidence rate decreased by 24% (RR, 0.76 [95% CI, .70-.83]). Significant decreases in incidence rates in 2020 were seen for HACO (RR, 0.75 [95% CI, .67-.84]) and CA (0.75 [.61-.92]) but not for HO CRE.

Conclusions: Adjusted CRE incidence rates declined from 2016 to 2020, but changes over time varied by epidemiologic class. Continued surveillance and effective control strategies are needed to prevent CRE in all settings.

Keywords: CRE; carbapenem-resistant Enterobacterales; trends in incidence.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Crude carbapenem-resistant Enterobacterales (CRE) incidence rates, overall and by epidemiologic class, 2016–2020. Abbreviations: CA, community-associated; HACO, healthcare-associated community-onset; HO, hospital-onset.
Figure 2.
Figure 2.
Crude carbapenem-resistant Enterobacterales (CRE) incidence rates by organism type, 2016–2020. A significant decreasing trend in incidence rate was seen for Klebsiella pneumoniae (P = .04) but not for Enterobacter cloacae complex (P = .23), Escherichia coli (P = .11), Klebsiella aerogenes (P = .16), or Klebsiella oxytoca (P = .50).
Figure 3.
Figure 3.
Crude incidence rates for the infection types associated with the incident carbapenem-resistant Enterobacterales (CRE) culture, 2016–2020. A significant decreasing trend in incidence rate was seen for urinary tract infection (UTI; P = .04), whereas a significant increasing trend was seen for sterile-site infection (P = .04).
Figure 4.
Figure 4.
Adjusted rate ratios (RRs) with 95% confidence intervals comparing annual 2017–2020 carbapenem-resistant Enterobacterales (CRE) incidence rates with the 2016 CRE incidence rate, using the current surveillance case definition (which was applied to all years starting in 2016). RRs were adjusted for case sex, race/ethnicity, and age. Abbreviations: CA, community-associated; HACO, healthcare-associated community-onset; HO, hospital-onset.
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